Overview of intestinal torsion syndrome
Intestinal torsion syndrome is a group of intestinal obstruction syndromes resulting from entanglement and kinking of the terminal ileum and sigmoid colon. It may result in obstruction of intestinal circulation and partial or complete closure of the intestinal lumen to produce a closed-loop intestinal obstruction. It occurs mainly in middle-aged and elderly people, and is more common in people over 45 years of age, with a higher incidence in men than in women. Torsion of the cecum and transverse colon is rare.
Etiology
The cause of the disease is unknown and may be related to anatomical variations. That is, the terminal ileum and sigmoid colon have long mesentery, one end of which is firmly fixed in the posterior peritoneum, which creates a section of intestinal tubes easy to rotate the conditions of activity, due to the turning over and the intestinal lumen of a large amount of accumulation of the effect of gravity, can be made to one intestinal tube entangled in the other intestinal tube, resulting in the inter-twisting and the more twisted the more tightly, and can not be reset on its own, the severe cases can appear strangulation of the intestinal obstruction.
Symptoms
It has the clinical manifestations of general intestinal torsion intestinal obstruction, with acute onset and rapid development. The patient has paroxysmal severe colic and abdominal distension in the middle and lower abdomen, and the defecation and elimination of gas stop. After the middle stage, nausea and vomiting may occur, and the vomit is gastrointestinal contents. In case of strangulation, the above symptoms will be aggravated, or even necrosis and perforation, and signs and symptoms of diffuse peritonitis, toxic shock and fluid and electrolyte disorders will appear.
Examination
Examination reveals a distended or bowel-shaped abdomen and abdominal tenderness, which is more severe at the site of the lesion. There are tympanic sounds on percussion and auscultation, and high-pitched bowel sounds and air-over-water sounds can be heard in the early stage, with bowel sounds diminishing or disappearing after the middle stage. Rectal fingerprinting often reveals absence of feces in the rectal jugular. When strangulation or perforation occurs, then it may present the sign of peritoneal irritation.
Radiographically, the sigmoid colon and small bowel are seen to show enlarged and distended colonic loops located in the right lower abdomen, whereas a group of distended small bowel images are seen on the left side of the abdomen.
Diagnosis
The possibility of this sign should be considered in all patients with acute intestinal obstruction, and the diagnosis can be confirmed by X-ray.
Differential diagnosis
It should be differentiated from intussusception, mechanical bowel obstruction, fecal impaction, and tumors.
Treatment
Because intestinal torsion has a tendency to recur, and is prone to strangulation and necrosis, diffuse peritonitis, toxic shock and severe metabolic disorders and death. Therefore, once diagnosed, early surgical treatment should be performed.
Prognosis
The mortality rate of patients with this syndrome without complications who are treated surgically within 24 hours is about 1%, while the mortality rate with intestinal gangrene can be as high as 4.5% to 31%.