Intestinal volvulus is a complete twisting of a loop of bowel around its mesenteric axis, producing sudden obstruction and rapid vascular compromise. Symptoms are dramatic and progress quickly:
- Explosive colicky pain
Severe, continuous abdominal pain starts abruptly and escalates; patients often writhe and cannot find relief . - Projectile vomiting
Gastric and then bilious vomiting occurs early, is profuse, and may eject a meter from the mouth as obstruction becomes high-grade . - Abdominal distension
The affected loop fills with gas and fluid, producing tense, tympanic distension that is tender to palpation. - Absent flatus and stool
Passage of gas and stool ceases; complete obstruction is the rule once the twist exceeds 360°. - Rebound tenderness and guarding
Localised peritonitis signs appear when mural ischemia develops; pain becomes constant and sharper. - Fever and tachycardia
Temperature may remain normal early, but rises quickly with bowel necrosis; pulse >120 beats/min and hypotension herald hypovolemic or septic shock . - Perforation and peritonitis
Sudden diffuse pain, board-like rigidity, and shock indicate perforation—an operative emergency.
Any patient with abrupt severe colic plus bilious vomiting and obstipation should be assumed to have a volvulus until proven otherwise; urgent imaging (CT or bedside ultrasound) and laparotomy are required.
| Symptom | Typical Pattern | Alarm for Gangrene/Perforation |
|---|---|---|
| Pain | Sudden, severe, colicky → constant | Diffuse, rebound, board-like |
| Vomiting | Early, bilious, projectile | Feculent if ileus |
| Distension | Rapid, tympanic | Increasing tenderness |
| Bowel | No flatus/stool | Absolute obstruction |
| Vitals | Tachycardia, later fever | Hypotension, shock |
| Imaging | Twisted loop, free fluid | Free air, pneumatosis |