VOLVULUS (Lat. volvere, to twist) is the term used in medicine to signify a twisting of the intestine, producing obstruction'to the passage of its contents. There are three distinct varieties of rotatory movement capable of giving rise to volvulus—(1) A portion of intestine may have become twisted on its own axis, and, in that case, even semi-rota tion brings the intestinal walls into contact, so as to close the passage. This is a rare condition, and only occurs in the ascending colon. (2) The mesentery (q.v.), or a part of it, may be twisted into a cone, dragging the intestine with it; the mesentery being the axis, and the intestine being rolled up upon it. This form occurs in the small intes tine. (3) A single portion or a coil of intestine may afford the axis round which another portion, with its mesentery, is thrown, so as to compress it, and close the passage. A coil of small intestine, the sigmoid flexure or the exeunt (see DIGESTION, ORGANS OF), may form the axis. All these varieties occur chiefly in advanced life, and their seat is commonly toward the posterior unyielding wall of the abdominal cavity, the smoothness and yielding nature of the parts anteriorly rendering such an event almost impossible. The symptoms of twisting of the intestines, especially of the sigmoid flexure. which is the most common seat of the affection, are usually very well marked from the beginning. Great pain is suddenly experienced in a small circumscribed spot of the abdomen, obsti nate constipation usually setting in from that date. If the sigmoid flexure, which lies just above the rectum, is the seat of the twisting, the abdomen soon becomes; distended, especially on the left side, the distention being much more marked than when the twist is in the small intestine, as might physiologically have been expected. Vomiting.
eonstant and copious, is usually present These cases are so desperate in their nnL that it is needless to enlarge upon their treatment. Attempts to remove the displace ment by injecting water or air into the intestine by means of a long tube have often been made, but with very slight success. Mr. Pollock, in his article on " Disease of the Alimentary Canal," in ilohnes's System of Surgery, remarks that "relief in twist of the sigmoid flexure is just possible without opening the abdomen, provided the long tube be introduced into the distended gut, its contents drawn off, and the twist he reduced by the altered position of the bowel. But no operation for the ultimate relief of the patient will be successful unless the intestine be unloaded first, and the twist then reduced."— Vol. ii. p. 1138. The operations that have been proposed for the relief of this and other intestinal obstructions are so often fatal, and, even when successful, leave the patient in so wretched a state, with an artificial outlet for the discharge of the contents of the bowels, that it is doubtful whether they should be recommended. It is simply a choice between almost certain death in a few days and a possible chance of a prolonged (but usually a miserable) existence. There are, however, a few rules that should be univer sally known and attended to—viz., wherever symptoms such as we have described occur, aperients should only be given by the rectum, while opium should be freely given by the mouth. Leeches and hot fomentations should be applied to the seat of pain; and all solid food should be prohibited, the nourishment being given solely in the fluid form.