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Q
Twisted Colon Consequences?

I was diagnosed with a twisted colon (cecal volvulus) and as a result had had 25 centimeters of my cecum/ilium/colon removed. I'm wondering what the long-term impact of this will be. Permanent weight loss? More or less bloating than before? Loose stools? Constipation?

A
Answer (Published 5/19/2011)

Cecal volvulus is twisting of a part of the colon called the cecum and the ascending segment of the colon. Normally, these two structures are fixed to the internal abdominal wall. If they become disconnected from the wall, they can move about and on rare occasions can get twisted. Symptoms of this change are crampy abdominal pain and swelling, sometimes with nausea and vomiting.

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X-rays of the affected area will show the cecum to be out of place and full of trapped air. A CT scan may reveal how tightly the volvulus is twisted. Sometimes, the problem can be reversed via a colonoscopy, but if blood supply is cut off, a portion of the colon can become necrotic (dead tissue), perforated, or gangrenous, requiring immediate surgery.

I discussed your question about the long-term effects of the removal of a section of your colon with Gerard E. Mullin, M.D., an integrative gastroenterologist at Johns Hopkins Medical Center in Baltimore. He explained that normally a sphincter muscle called the ileocecal valve - located where the small and large intestine (colon) meet - keeps the contents of these two structures separate. Bacterial counts are normally much higher in the large intestine. (The colon contains more than one billion bacteria per milliliter of fluid, compared to fewer than 10,000 bacteria per milliliter of fluid in the small intestine.) After surgical removal of the ileocecal valve, bacteria from the colon begin to migrate into the small intestine. This can lead to a condition known as "small intestine bacterial overgrowth" or SIBO, marked by bloating and distension plus flatulence, diarrhea, and abdominal pain.

Dr. Mullin says that most physicians treat SIBO with antibiotics, which can work but sometime have adverse consequences. He prefers to use oregano oil, wild garlic and berberine (the active constituent of Oregon grape root and other plants used as GI remedies), which can help reduce bacterial growth in the small intestine. He adds that digestive enzymes can also help, as can a diet low in sweets and legumes, which encourage bacterial overgrowth and gas production. For all of these supplements, he suggests following the dosing directions on the package labels.

Andrew Weil, M.D.

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