Visceral volvulae and management

Volvulus refers to torsion of a segment of the gastrointestinal tract, which often leads to bowel obstruction. Obstruction of the intestinal lumen and impairment of vascular perfusion occur when the degree of torsion exceeds 180° and 360°, respectively. Visceral volvulus causing obstruction is a common presentation to the emergency department. Ascertaining the gastrointestinal level and grading the severity of the obstruction is paramount as each can be managed entirely differently. A spectrum from nasogastric or rectal tube decompression, to endoscopic decompression with or without fixation, and finally, surgical intervention are all at the surgeon's disposal. Clinical and radiographic assessment of both the pathological process and the patient provide all the necessary detail for appropriate management of what is often a highly comorbid cohort of patients. This article will summarize current evidence for management of the most common sources of volvulus; gastric, small bowel, and colonic.