Intestinal torsion Intestinal torsion is a segment of intestinal collaterals rotating along the long axis of the mesentery or two segments of intestinal collaterals twisting into a knot and causing closed-collar intestinal obstruction, the former is common. It is often because the intestinal collaterals and their mesentery are too long, and the intestinal lumen is narrowed by pressure after intestinal torsion, causing obstruction, torsion and compression affecting the blood supply of the intestinal tube, therefore, the intestinal obstruction caused by intestinal torsion is mostly strangulated.
Intestinal torsion has general symptoms of intestinal obstruction, but the onset is rapid, the pain is severe, the patient is tossing and turning, and shock can appear early. Intestinal torsion is mostly seen in clockwise rotation, and the degree of torsion is less than 360° in mild cases, and up to 2-3 turns in severe cases. The symptoms vary slightly depending on whether the small intestine or sigmoid colon is twisted.
Small intestine torsion: acute small intestine torsion is mostly seen in young adults. There are often triggering factors such as strenuous activity after a full stomach, and those occurring in children are often associated with congenital intestinal malrotation. The abdominal pain often involves the lower back, and the patient often does not dare to lie flat on his back, but prefers to take the chest and knee position or curl up on his side; vomiting is frequent, abdominal distension is not significant or especially obvious in one part, and there can be no high-pitched bowel sounds. Dilated intestinal collaterals can sometimes be found in the abdomen with pressure pain. The disease is prone to shock when it is a little late. The abdominal X-ray is consistent with strangulated intestinal obstruction. In addition, there are signs specific to jejunum and ileum transposition, or small spans of curled intestinal collaterals arranged in multiple patterns.
Sigmoid colon torsion: Mostly seen in elderly men, often with constipation habits, or a past history of multiple episodes of abdominal pain relieved by exhaustion and defecation. Clinical manifestations, in addition to abdominal cramps, have obvious abdominal distension, while vomiting is generally not obvious. If a low-pressure enema is made, often less than 500 ml can no longer be instilled. Barium enema X-ray examination shows that the barium is obstructed at the site of torsion, and the tip of the barium shadow is in the shape of a “beak”.
Treatment Intestinal torsion is a more serious mechanical intestinal obstruction, can often occur in a short period of intestinal strangulation, necrosis, mortality rate of 15-40%, the main cause of death is often too late or delayed treatment, generally should be timely surgery.
(a) torsional repositioning The torsional intestinal collaterals are repositioned in the opposite direction of their torsion. If the mesenteric blood circulation is well restored and the intestinal canal has not lost its vitality after resetting, it is necessary to solve the problem of recurrence prevention.
(B) intestinal resection is suitable for cases with intestinal necrosis, and the small intestine should be resected and anastomosed in the first stage. The sigmoid colon is generally safer to resect the necrotic intestinal segment and then perform enterostomy at the severed end, followed by second-stage surgery for intestinal anastomosis.