Volvulus: A Nursing Perspective
Abstract
Volvulus is a gastrointestinal condition characterized by the twisting of the intestine, leading to bowel obstruction. It is a medical emergency requiring prompt diagnosis and intervention. This article provides an overview of volvulus, including its pathophysiology, clinical presentation, nursing interventions, and management strategies.
Introduction
Volvulus occurs when a segment of the intestine twists around itself, causing obstruction, ischemia, and potential necrosis. The most commonly affected areas are the sigmoid colon and cecum. It can be congenital or acquired and is often associated with conditions such as chronic constipation, megacolon, or adhesions from previous surgeries (Ghosh et al., 2021).
Pathophysiology
The twisting of the intestine leads to obstruction of the lumen and compromised blood flow. If untreated, it can progress to bowel necrosis, perforation, peritonitis, and sepsis. The extent of vascular compromise determines the severity of complications (Ferrer-Márquez et al., 2020).
Clinical Presentation
Patients with volvulus may present with:
• Severe abdominal pain and distension
• Nausea and vomiting
• Constipation or obstipation
• Reduced or absent bowel sounds
• Signs of peritonitis in severe cases
Diagnosis
• Abdominal X-ray: “Coffee bean†or “bird’s beak†sign
• CT scan: Confirms obstruction and identifies complications
• Endoscopy: Used for decompression in selected cases
Nursing Interventions
1. Assessment
• Monitor vital signs, abdominal girth, and pain levels
• Assess bowel sounds and monitor for signs of perforation or sepsis
2. Acute Management
• NPO (Nothing by Mouth) to prevent further distension
• IV fluid resuscitation to maintain hemodynamic stability
• Nasogastric tube placement for decompression if indicated
• Pain management (opioids cautiously, as they may mask symptoms)
3. Postoperative Care (if surgical intervention is needed)
• Monitor for complications such as infection or anastomotic leakage
• Encourage early ambulation to prevent ileus
• Educate the patient on dietary modifications and bowel regimen
Conclusion
Nurses play a critical role in the early recognition, management, and post-treatment care of patients with volvulus. Timely intervention reduces morbidity and improves outcomes.
References
• Ferrer-Márquez, M., et al. (2020). Management of colonic volvulus: A comprehensive review. World Journal of Gastrointestinal Surgery, 12(6), 179-189.
• Ghosh, S., et al. (2021). Sigmoid volvulus: Diagnosis and treatment updates. International Journal of Surgery, 89, 105938.