Twisted Bowel: Symptoms and Causes of Twisted Bowel Syndrome

Twisted bowel syndrome is characterized by abnormal intestinal twisting, and arises due to dietary factors, abnormal peristalsis, abdominal adhesions, etc. The current article describes this syndrome with respect to its etiology and symptoms.
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Twisted bowel or volvulus implies an abnormal looping and twisting of the intestine (small or large), resulting in bowel obstruction. Such obstruction hampers intestinal blood supply, and may lead to death (necrosis) of the gut tissue.

Abnormal twisting of small intestine is termed as small bowel volvulus, whereas colonic volvulus refers to large intestinal twisting. Colonic volvulus is of two types - sigmoid and cecal - depending on the colonic region affected.

Given below are the causes behind such an abnormality, as well as the symptoms, diagnostic methods and treatment options available.

Symptoms
The symptoms experienced due to a twisted bowel may vary depending on the affected portion, extent of severity as well as age and medical history. In the initial stages, the individual may experience mild transient symptoms. However, if the problem persists for a long time, it may block the supply of blood, and hence oxygen and nutrients, to the remaining gastrointestinal tract. This severe medical condition is termed as intestinal strangulation, and may lead to bowel necrosis (death of bowel tissue), if untreated or ignored.

The common signs and symptoms associated with a twisted gut are:
  • • Nausea
  • • Abdominal pain
  • • Bowel sounds
  • • Constipation
  • • Bloating
  • • Flatulence
  • • Bloody stools
  • • Abdominal distention
  • • Abdominal tenderness

Causes

Precise cause behind the looping over of intestinal tissues is not clear. However, it has been attributed to the following causes:

► Increased Gut Motility
High intensity contractions of the peristaltic muscles may sometimes lead to twisting of certain intestinal parts. Such a high peristaltic tone can be the result of high-fiber diet, intestinal motility disorders or increased use of laxatives.

► Bulky Meals
A bulky bolus causes the intestinal part to loop or distend downwards. This can initiate a rotation in the peritoneal layers, and may lead to volvulus.

► Intestinal Malrotation
This is congenital condition involving an incomplete rotation of the intestine, resulting in abnormal intestinal positioning and shape. It has been observed that infants born with intestinal malrotation are at higher risk of developing volvulus.

► Diverticulosis
In this condition, protrusions arise from the intestinal lining, to form sac like structures called diverticula. Such sacs may be congenital (Meckel's diverticulum) or may develop later in life. The presence of multiple diverticula on a single part of the intestine causes it to distend out of position, and twist on itself, thereby causing volvulus.

► Abdominal Adhesions
Abnormal bands of tissue may develop between abdominal organs, due to infections or post-surgery complications. In women, bowel endometriosis (growth of endometrial cells in the intestines) may lead to the formation of such bands. These abdominal adhesions disturb the normal positioning of abdominal organs, and may introduce kinks and twists in the intestine.

► Other Causes
The development of volvulus may also arise during pregnancy or due to post-surgery complications or as a manifestation of certain intestinal cancers. It is also associated with old age and changes in dietary habits, etc.

Diagnosis and Treatment

Twisted bowel syndrome is diagnosed by conducting barium enema, stool analysis, and imaging techniques such as radiography, computed tomography (CT) and magnetic resonance imaging (MRI). Diagnostic or exploratory laparotomy, a minimally invasive surgical technique, may be advised to examine the abdominal organs.

The treatment options include surgical untwisting of the intestines through therapeutic laparotomy and laparoscopy. If necessary, the affected portion may be widened so as to prevent future complications. In severe cases, the necrotic part of the intestine is excised, and the healthy regions are joined together. Medications are often prescribed to avoid complications and infections.

Twisted bowel syndrome is a complex condition with an uncertain etiology. Although some causative factors have been identified, there exist instances wherein the precise cause cannot be identified. The incidence of twisted bowel is rare but serious, and demands an early diagnosis and treatment.

Disclaimer: This Buzzle article is for informative purposes only, and should not be used as a substitute for professional medical advice.
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Last Updated: January 15, 2013
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