Intestinal Twists: Risks and Treatment Options - Gastroenterology and Hepatology

Intestinal volvulus, how to treat it?

Dear Dr.
You,
My father is 63 years old and last week he visited Taitung Christian Hospital.
The gastroenterology department recommended a CT scan and found that there is a kink in his intestines.
They suggested a surgical intervention to relieve the obstruction.
I would like to ask if there is an immediate risk involved.
Should we seek a second opinion, considering that medical resources in Taitung are relatively limited?
Thank you,
Chen Ping

Chen, 40~49 year old female. Ask Date: 2008/12/22

Dr. You Ligang reply Gastroenterology and Hepatology

Dear Chen Ping,
In cases of intestinal obstruction, clinical symptoms must be assessed, as there is a risk of blood flow obstruction to the intestines, which can lead to necrosis and pose a life-threatening situation.
Generally, initial treatment involves conservative management such as fasting, intravenous fluids, stool softeners, prokinetic agents, enemas, nasogastric tube drainage, and rectal tube insertion.
However, if there is no improvement or if signs of peritonitis develop, it is crucial to consult a surgeon promptly to evaluate the need for immediate surgery.
Wishing you safety and health.
Sincerely,
Dr.
Liu Li-Kuang
Attending Physician, Gastroenterology
Taoyuan Hospital, Department of Health

Reply Date: 2008/12/22

More Info

Understanding intestinal twists, also known as volvulus, is crucial for recognizing the associated risks and treatment options. Volvulus occurs when a portion of the intestine twists around itself, leading to obstruction and potentially compromising blood flow to the affected area. This condition can result in severe complications, including ischemia (lack of blood supply), necrosis (tissue death), and perforation of the bowel, which can be life-threatening.

Risks of Intestinal Twists
1. Acute Abdominal Pain: Patients often present with sudden and severe abdominal pain, which may be accompanied by distension and vomiting. The pain can be intermittent or constant, depending on the severity of the twist.

2. Bowel Obstruction: As the intestine twists, it can obstruct the passage of contents, leading to symptoms such as constipation or inability to pass gas. This can escalate quickly, requiring urgent medical intervention.

3. Ischemia and Necrosis: If blood flow is compromised for an extended period, the affected segment of the intestine can become ischemic and eventually necrotic. This condition necessitates immediate surgical intervention to prevent further complications.

4. Perforation: In severe cases, the pressure from the twisted bowel can lead to perforation, resulting in the leakage of intestinal contents into the abdominal cavity, which can cause peritonitis—a serious and potentially fatal condition.

Treatment Options
1. Surgical Intervention: The primary treatment for volvulus is surgical intervention. The surgeon may untwist the affected segment of the intestine and assess the viability of the tissue. If the bowel is necrotic, resection (removal) of the affected segment may be necessary.

2. Endoscopic Decompression: In some cases, especially in older patients or those with significant comorbidities, endoscopic techniques may be employed to decompress the twisted bowel. This approach can relieve the obstruction without the need for immediate surgery.

3. Postoperative Care: After surgery, patients will require careful monitoring for signs of complications, such as infection or further obstruction. Nutritional support may also be necessary, especially if a significant portion of the bowel was resected.

Seeking a Second Opinion
Given your father's situation, it is entirely reasonable to seek a second opinion, especially if you have concerns about the adequacy of care in your current medical facility. A second opinion can provide reassurance or alternative treatment options and is a common practice in medical care. When seeking a second opinion, consider the following:
- Consult a Specialist: Look for a gastroenterologist or a colorectal surgeon with experience in managing volvulus and related conditions.

- Bring Medical Records: Ensure that you have all relevant medical records, imaging studies, and test results available for the new physician to review.

- Ask Questions: Prepare a list of questions regarding the diagnosis, treatment options, risks, and expected outcomes to facilitate a thorough discussion.

Conclusion
In summary, intestinal twists pose significant risks that require prompt diagnosis and treatment. Surgical intervention is often necessary to prevent serious complications. Seeking a second opinion is a prudent step, especially if you have concerns about the initial recommendations. It is essential to ensure that your father receives the best possible care tailored to his specific medical needs. Always prioritize open communication with healthcare providers and advocate for your loved one's health.

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