Disorders of the Gastrointestinal System, 2nd Edition
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Volvulus can cause various symptoms depending on where in the GI system it is. Gastric volvulus symptoms include the Borchardt triad—pain, vomiting, and inability to pass a nasogastric tube into the stomach—and occur in up to 70% of patients with the condition (Hope, 2021). If the volvulus is farther down in the GI system, the pain and symptoms may be confused with cardiac events and could be missed. Bloody stools, constipation, and shock may also occur (Hope, 2021). Immediate treatment is necessary to pre- vent life-threatening complications. Such complications include strangulation of the twisted portion of the bowel, ischemia, infarction, perforation, and fatal peritoni- tis (Hodin, 2022). The symptoms of volvulus may mimic other disorders. Appropriate diagnostic tests include the following (Hope, 2021): ● X-rays : Obstruction can be identified, as can trapped air and absence of air above and below the level of the volvulus ● CT scans : Reliable and fast diagnosis may be possible with a CT scan, but plain x-rays can often diagnose the condition, so CT scans are not always the first-line diagnostic test. ● Upper GI endoscopy: Signs of gastric volvulus include incomplete obstruction and difficulty passing the tubes through to complete the study and allow for direct visualization of the rotation of the stomach. ● Barium enema : Barium enema can show specific areas of the colon that are affected. In volvulus of the cecum, barium fills the colon distal to the affected area. In sigmoid volvulus, findings vary in children and adults. The barium may twist and appear as a point or beak (Hodin, 2022).
| NURSING CONSIDERATION
Barium enema should be avoided if perforation or gangrene is suspected, as barium spilling into the peritoneum can be deadly (Thornton, 2022). Treatment varies with the age and con- dition of the patient and whether compli- cations have occurred. In the event of a necrotic bowel (as a result of obstruction or strangulation), immediate surgical re- section and anastomosis are indicated (Hodin, 2022. Surgical approaches to treating a volvulus include partial colec- tomy (removal of the affected area of the colon) and anastomosis (reconnection of healthy sides). Hartmann procedure is also an indication, especially if the peri- toneal cavity is contaminated from perfo- ration or infection. If peritonitis is present, anastomosis may not be possible, and a temporary or permanent colostomy may be necessary to facilitate the excretion of waste (Thornton, 2022). Treatment for a gastric volvulus can include removal of affected stomach areas, endoscopic re- duction, elimination of contributing fac- tors such as diaphragmatic hernia, or dia- phragm repair (Hope, 2021). Sometimes in adults with sigmoid vol- vulus, a nonsurgical reduction is success- ful. An example is endoscopic detorsion, which simply involves correcting the twisted bowel with an endoscope (Hodin, 2022). A sigmoidoscope is carefully and gently inserted to assess the damage. While the scope is inserted, the air is in- stilled to assist with visualizing the area of concern. In some cases, the air pressure itself can correct the volvulus (Thornton, 2022). Other non-surgical treatments in- clude fluid and electrolyte imbalance corrections and the insertion of a rectal tube to decompress the bowel (Thornton, 2022).
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