How is mesenteric volvulus of the small intestine treated?
Nov 06, 2025
Source: Cainiu Health
Dr. Li Jingxiang
Introduction
In general, mesenteric volvulus of the small intestine is an acute abdomen condition caused by rotation of the small bowel mesentery around its axis, leading to intestinal ischemia and obstruction. Common symptoms include sudden severe abdominal pain, vomiting, and cessation of flatus and defecation. Treatment options mainly include gastrointestinal decompression, fluid resuscitation, pharmacological therapy, surgical intervention, and supportive care.
Generally, mesenteric volvulus is an acute abdomen condition caused by the rotation of the small bowel mesentery around its axis, leading to intestinal ischemia and obstruction. Common symptoms include sudden severe abdominal pain, vomiting, and cessation of flatus and defecation. Treatment methods mainly include gastrointestinal decompression, fluid resuscitation, medication, surgical intervention, and general supportive care. Specific details are as follows:
1. Gastrointestinal Decompression
A nasogastric tube is inserted through the nose into the stomach to continuously remove gas and fluids from the gastrointestinal tract. This reduces intraluminal pressure, alleviates bowel distension, and relieves symptoms such as abdominal pain and vomiting. The method helps reduce compression on the mesenteric vessels, improves blood flow to the intestine, and creates favorable conditions for further treatment. It is a key supportive measure in the initial phase of management.
2. Fluid Resuscitation
Patients often experience dehydration and electrolyte imbalances due to vomiting and fasting. Intravenous infusion of normal saline, glucose solution, potassium chloride, and other fluids is necessary to restore blood volume, correct electrolyte and acid-base disturbances, and maintain circulatory stability. This prevents worsening of intestinal ischemic injury due to circulatory collapse.
3. Medication Therapy
Under medical guidance, patients may receive anti-infective agents such as ceftriaxone sodium for injection and metronidazole injection to prevent or control infections arising from intestinal ischemia and necrosis. For severe pain, pethidine hydrochloride injection can be used for analgesia, but only after a definitive diagnosis has been established to avoid masking disease progression. Additionally, omeprazole injection may be administered to suppress gastric acid secretion and reduce gastrointestinal irritation.
4. Surgical Treatment
Surgery is the key treatment for mesenteric volvulus. Common procedures include detorsion of the mesentery and bowel resection. If the bowel remains viable, surgical detorsion of the twisted mesentery and intestine can restore blood supply. However, if intestinal necrosis has occurred, the nonviable segment must be resected to prevent sepsis and reduce the risk of toxic shock. Surgery is indicated for patients with failed conservative management or severe clinical presentation.
5. General Supportive Care
Patients should remain strictly bedridden to avoid aggravating the mesenteric twist. Fasting and nothing by mouth (NPO) are required to reduce gastrointestinal burden. Vital signs—including body temperature, blood pressure, and heart rate—should be closely monitored, along with changes in symptoms such as abdominal pain and vomiting. After symptom improvement, patients can gradually resume a liquid and then semi-liquid diet, avoiding spicy and greasy foods to promote recovery of gastrointestinal function.
In addition, patients must strictly follow medical advice during treatment. If any abnormalities occur—such as worsening abdominal pain, high fever, or altered mental status—they should immediately inform their physician so that the treatment plan can be promptly adjusted to prevent disease progression.
