What Causes A Twisted Bowel In Adults And Children?

A twisted bowel, known medically as volvulus, is a serious condition where a loop of the intestine twists around itself and its supporting tissue. This twist cuts off the blood supply to that section of the bowel, which can lead to tissue death, perforation, and severe infection if not treated quickly. In adults, the most common cause is abnormal intestinal rotation or adhesions from prior surgery, while in children, it often results from a birth defect called malrotation. Regardless of age, a twisted bowel is a medical emergency that requires immediate hospital care.

What Exactly Happens When The Bowel Twists?

Picture the intestines as a long, flexible tube packed neatly inside the abdomen. The tube is held in place by bands of tissue called the mesentery, which carries the blood supply to the bowel wall. When a section of the bowel twists, it also twists the mesentery attached to it.

This twisting acts like a kink in a garden hose. It blocks the passage of food, fluid, and gas, causing a bowel obstruction. More dangerously, it pinches the blood vessels in the mesentery. Without blood flow, the affected intestinal tissue starts to die within hours. Dead bowel tissue can leak bacteria and toxins into the abdominal cavity, causing peritonitis, a life-threatening infection.

In medical terms, this is called ischemia. If ischemia is not reversed quickly, the bowel becomes necrotic and must be surgically removed. The speed of treatment is the single biggest factor in how well a person recovers.

What Causes A Twisted Bowel In Adults And Children?

The causes differ significantly between adults and children because the reasons behind the twist are distinct.

In newborns and infants, the leading cause is intestinal malrotation. This is a birth defect where the intestine does not complete its normal rotation and fixation inside the abdomen during fetal development. Because the bowel is not anchored properly, it can swing freely and twist, a condition called midgut volvulus. This most often appears in the first weeks or months of life.

In adults, the twist usually happens for different reasons. The sigmoid colon, the S-shaped section at the end of the large intestine, is the most common site. Adult volvulus is frequently linked to chronic constipation, a high-fiber diet in some parts of the world, or an unusually long and mobile colon. Prior abdominal surgery is another major factor because it can create adhesions, which are bands of scar tissue that can pull the bowel into an abnormal position and allow it to twist.

Adults can also develop a cecal volvulus, which involves the first part of the large intestine. This is less common and often related to a naturally loose cecum that has not properly attached to the abdominal wall.

How Do Symptoms Differ Between Children And Adults?

Recognizing the symptoms early matters because a twisted bowel progresses rapidly.

In babies and young children, the classic signs come on suddenly. A healthy baby may start crying inconsolably and draw their knees up to their chest. They may vomit green or yellow fluid, which indicates bile, and this is a critical warning sign. The abdomen may appear swollen, and the baby may pass bloody stools or stop passing stool entirely. In an infant, bilious vomiting is always considered an emergency until proven otherwise.

In adults, symptoms also begin abruptly. Severe, crampy abdominal pain is the most common complaint. The pain often comes in waves as the bowel tries to push contents past the blockage. Adults may also experience nausea, vomiting, abdominal distension, and the inability to pass gas or stool. As the condition worsens and blood flow is cut off, the pain may become constant and severe. A rapid heart rate, fever, and signs of shock indicate the bowel may already be dying.

One key difference is that adults can sometimes have a chronic or recurring form of volvulus, where the bowel twists and untwists on its own. This causes intermittent pain and bloating that resolves temporarily. This pattern can delay diagnosis because the symptoms come and go.

What Are The Risk Factors For A Twisted Bowel?

Several conditions and circumstances increase the likelihood of a volvulus.

For children, the primary risk factor is malrotation present at birth. There is no known way to prevent this developmental issue. It is simply a structural difference that some infants are born with.

For adults, the risk factors are more varied:

• Previous abdominal surgery: Adhesions from operations like appendectomy, hysterectomy, or colon surgery can create points where the bowel can twist.
• Chronic constipation: Long-term straining and a distended colon can make the sigmoid colon longer and more mobile over time.
• High-fiber diets: In some populations, very high fiber intake is associated with sigmoid volvulus, likely because it increases the bulk and weight of the colon.
• Neurological conditions: Diseases like Parkinson’s disease that cause chronic constipation and reduced bowel motility raise the risk.
• Pregnancy: Hormonal changes and the growing uterus can shift the position of the bowel, slightly increasing the risk during pregnancy.
• Older age: The condition is more common in people over 60, partly due to weakened abdominal muscles and longer transit times in the colon.

How Is A Twisted Bowel Diagnosed?

Diagnosis is time-sensitive. Doctors start with a physical exam and a review of symptoms, but imaging is required to confirm the twist.

A CT scan is the most accurate imaging test for volvulus in adults. It can show the characteristic “whirl sign,” which is the twisted mesentery and blood vessels seen on the scan. CT scans are fast and highly reliable for identifying both the twist and any signs of bowel ischemia.

For infants and children, doctors often use an upper GI series. This involves swallowing a contrast dye that shows up on X-rays. In a child with malrotation, the dye will show the abnormal position of the junction between the stomach and the small intestine. If the dye stops suddenly, it indicates a twist is present. In some cases, an abdominal X-ray alone can suggest the diagnosis if it shows a massively dilated bowel loop.

An ultrasound is sometimes used in infants because it avoids radiation, but it is less definitive than an upper GI series. Blood tests are helpful but not diagnostic. They can show elevated white blood cell counts, which indicate infection or tissue death, but they cannot confirm the twist itself.

What Is The Treatment For A Twisted Bowel?

There is no home remedy or non-surgical cure for a fully twisted bowel. This is a surgical emergency.

In adults with sigmoid volvulus, doctors may first attempt a procedure called sigmoidoscopy with decompression. A flexible tube is passed through the anus into the colon to reach the twisted area. The doctor tries to gently untwist the bowel and release the trapped gas and fluid. This procedure can relieve the obstruction and buy time, but it is not a permanent fix. The volvulus often recurs, so surgery is usually planned to prevent future episodes.

Surgery is always required for children with midgut volvulus. The procedure, called a Ladd procedure, involves untwisting the bowel, dividing the abnormal bands of tissue that caused the malrotation, and repositioning the intestines so they are less likely to twist again. The appendix is often removed during this surgery because its position will be unusual, making future appendicitis harder to diagnose.

In adults, surgery involves untwisting the bowel and assessing its health. If the tissue is still pink and viable, the surgeon may fix the bowel in place or remove a portion of it to prevent recurrence. If the bowel is dead or perforated, that section must be removed. In severe cases where the patient is critically ill, the surgeon may create a colostomy, bringing the end of the bowel to the surface of the abdomen, to allow the remaining intestine time to heal.

Can A Twisted Bowel Be Prevented?

For children with malrotation, there is no prevention. The condition is present from birth, and the first episode of twisting is often the first sign of the problem.

For adults, prevention focuses on reducing the underlying risk factors. Managing chronic constipation with adequate fluid intake, regular physical activity, and appropriate use of laxatives under medical guidance may help reduce the risk of sigmoid volvulus. Avoiding unnecessary abdominal surgeries reduces the risk of adhesion formation.

For adults who have experienced one episode of sigmoid volvulus that was treated without surgery, the recurrence rate is high. Many surgeons recommend elective surgery to remove the redundant colon segment and permanently prevent another twist. This decision is made based on the patient’s age, overall health, and surgical risk.