Infants, who have developed volvulus due to intestinal malrotation, suffer from signs and symptoms similar to those of bowel obstruction. Symptoms tend to get so severe, that the infant needs immediate hospitalization. Affected infants present with the following signs and symptoms:

• Nausea accompanied by vomiting
• Constipation
• Passing blood or dark colored stools
• Vomiting up green colored bile like material
• Tenderness in the abdominal region
• Abdominal distention
• Shock 

In addition, affected individuals would also complain of recurrent attacks of abdominal pain accompanied by several vomiting bouts which tend to cease without treatment. Such symptoms are characteristic of condition known as intermittent volvulus; wherein the bowel suddenly twists giving rise to unpleasant symptoms and untwists by itself [7].

Several tests are employed for diagnosing the condition of volvulus. At preliminary level, preliminary physical examination is carried out after obtaining a careful medical profile of the patient. Thereafter, stool tests are done to determine presence of blood in it. Abdominal X-rays help in confirming the condition of volvulus, especially when they show signs of coffee bean shape of the air filled loop of the colon [8]. If this does not help in arriving at appropriate diagnosis, then barium enema tests would be carried out. Following this, imaging studies such as CT scan of the abdomen would be required which would show signs of intestinal volvulus [9].

Under emergency situation, surgical procedures would be required to correct the twisted volvulus. In such procedures, the bowels are corrected and the blood supply re-established. When there are signs of necrosis, the dead tissue is removed and the ends are joined back. In other cases, colostomy or ilesostomy is done, so that the intestinal contents can be removed through the tube [10].

Outcome of patients with volvulus is good if the condition is diagnosed on time and prompt treatment initiated. In cases, when the bowel undergoes necrosis the outcome is poor. This is a potentially life threatening condition, which can further call for secondary complications to set in.

Volvulus that strikes the children or infants usually occurs due to birth defect called congenital intestinal malrotation. In such conditions volvulus occurs during the early years of life. However, there are instances, when the condition can occur even without a malrotation. Other causative factors include adhesions, abnormal intestinal contents can also favor the development of segmental volvulus [2]. Types of volvulus other than segmental volvulus commonly strike the adult population and majorly occur due to constipation and or surplus intestinal tissue [3].

The incidence of malrotation occurs in about 1 in 200 or 1 in 500 live births. Majority of the cases of malroration seldom produce any symptoms and therefore goes unreported. Based on this, the true incidence of the condition is still not known. Symptomatic malrotation is known to occur in 1 in 6000 live births [4]. Colonic volvulus is one of the major causes of large bowel obstruction after diverticulitis and cancer; this is based on the figures available from the US government. Males and females are affected in equal numbers, and the disease strikes the adult population in the eighth decade [5].

Chronic constipation as well as excessively high fibrous diet can exert undue pressure on the sigmoid colon, making it susceptible to torsion. Individuals with a gravid uterus or those with huge pelvic mass are also susceptible to develop volvulus. Repeated attacks of torsion cause the base of sigmoid colon to become shortened. The loop becomes inflamed and forms paddle-like configuration.

Intestinal malrotation is a birth defect, which occurs during fetal development. Three stages make up for the development of bowel during fetal growth period. Factors that interfere with normal rotation of the gut during embryonic development cause volvulus to set in. This in turn is associated with abnormalities concerning the gastrointestinal system, which paves way for development of defects of abdominal wall or condition of congenital diaphragmatic hernia [6].

The onset of volvulus cannot be prevented; more so if it occurs due to congenital defect. The progression of the disease can be prevented by prompt diagnosis and immediate initiation of treatment.

Volvulus primarily occurs due to birth defect known as congenital intestinal malrotation. Malrotation develops when the bowel does not get aligned properly during fetal growth. In such instances the bowel no longer is attached to the abdominal wall, which further causes it to shift from its original position and twist. Volulus can also occur in absence of underlying birth defect. There are several types of volvulus such as sigmoid volvulus, cecal volvulus, gastric volvulus, volvulus neonatorum and volvulus of the small intestine. One of the rare types of volvulus is the volvulus of splenic flexure [1].

• Definition: Volvulus is a condition, characterized by development of twist in the intestine which gradually obstructs the blood flow causing necrosis of the affected part. In such a condition there is axial rotation of a part of the bowel. There are several types of volvulus which are categorized based on underlying etiology.
• Cause: Congenital defect that causes intestinal malrotation is the major cause of volvulus. However, there are other factors that can favor development of volvulus without the presence of malrotation.
• Symptoms: Infants with volvulus would experience signs and symptoms similar to bowel obstruction. These include, nausea accompanied by vomiting, pain in the abdomen, abdominal distention, passing dark colored or blood in stool, constipation and recurrent bouts of vomiting.
• Diagnosis: Preliminary physical examination followed by stool test is done to evaluate the presence of blood in stools. Imaging studies such as CT scan of the abdomen would provide more useful insights about the condition. In addition, barium enema test is also indicated. In many instances, X-ray of the abdomen would be enough to arrive at a definite diagnosis. When the findings are inconclusive, then other tests are required.
• Treatment: Presence of severe signs and symptoms would indicate immediate hospitalization in order to prevent secondary complications to set in. Such a kind of situation would indicate immediate surgical procedures to correct the twisted intestine. The part of the intestine that has undergone necrosis would also be removed and the healthy ends joined back. Procedures such as ileostomy or colostomy may be performed depending on the condition.

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