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:

1. Explosive colicky pain
   Severe, continuous abdominal pain starts abruptly and escalates; patients often writhe and cannot find relief .
2. Projectile vomiting
   Gastric and then bilious vomiting occurs early, is profuse, and may eject a meter from the mouth as obstruction becomes high-grade .
3. Abdominal distension
   The affected loop fills with gas and fluid, producing tense, tympanic distension that is tender to palpation.
4. Absent flatus and stool
   Passage of gas and stool ceases; complete obstruction is the rule once the twist exceeds 360°.
5. Rebound tenderness and guarding
   Localised peritonitis signs appear when mural ischemia develops; pain becomes constant and sharper.
6. 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 .
7. 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.