The Pathogenesis and Etiology of Colonic Volvulus

Colonic volvulus is an axial rotation of the colon around a fixed point, usually the mesentery. All segments of the colon have been reported to volvulize. Volvulus most commonly involves the sigmoid colon. However, it can involve, in order of decreasing frequency, the cecum, transverse colon, and splenic flexure. In some instances the volvulus may cause obstruction of venous outflow, arterial inflow, or both, resulting in intestinal ischemia and eventually gangrene. Although much has been written about possible etiologies and pathogenesis of colonic volvulus there is little evidence directly implicating any single etiologic factor. It appears that sigmoid volvulus is an acquired condition, whereas volvulus of the right colon is congenital in origin.