[2] The mesentery may become so tightly twisted that blood flow to part of the intestine is cut off, resulting in ischemic bowel.

[2] Risk factors include a birth defect known as intestinal malrotation, an enlarged colon, Hirschsprung disease, pregnancy, and abdominal adhesions.

[6] Diagnosis is typically with medical imaging such as plain X-rays, a GI series, or CT scan.

Volvulus causes severe pain and progressive injury to the intestinal wall, with accumulation of gas and fluid in the portion of the bowel obstructed.

Acute volvulus often requires immediate surgical intervention to untwist the affected segment of bowel and possibly resect any unsalvageable portion.

Volvulus can also occur in patients with Duchenne muscular dystrophy due to smooth muscle dysfunction.

The symptoms are intractable retching, pain in the upper abdomen and inability to pass nasogastric tube into the stomach.

Segmental volvulus occurs in people of any age, usually with a predisposition because of abnormal intestinal contents (e.g. meconium ileus) or adhesions.

If a perforation is suspected, barium should not be used due to its potentially lethal effects when distributed throughout the free intraperitoneal cavity.

The scan will show mesenteric stranding in the involved segment of edematous colon which is usually in the sigmoid region.

The obstruction may be acute or chronic after years of uncontrolled disease leads to the formation of strictures and fistulas.

If the mucosa of the sigmoid looks normal and pink, a rectal tube for decompression may be placed, and any fluid, electrolyte, cardiac, kidney or pulmonary abnormalities should be corrected.

In a cecal volvulus, the cecum may be returned to a normal position and sutured in place, a procedure known as cecopexy.

[1] If identified early, before presumed intestinal wall ischemia has resulted in tissue breakdown and necrosis, the cecal volvulus can be detorsed laparoscopically.