This is a rare obstruction, constituting about one-fortieth of an intestinal obstructions. Men are said to have this affection oftener than women. The cause is probably an extra-wide mesentery. Invagination is probably made possible from the same cause.

Volvulus symptoms are tympanitis; great peristatic pain; inability to have an action from the bowels after the segment below the obstruction is emptied with enemas.

At first the pain is periodic. It gradually increases and becomes more constant. If no food is given from the start, pain will not be so marked. Vomiting will be a more or less constant symptom. Symptoms must vary to agree with the temperament and excitability of the patient.

The disease is so rare that a diagnosis will be made after an operation. Any case presenting symptoms of obstruction with symptoms of profound prostration--giving the appearance of being on the verge of collapse--should be opened up, and whatever is found should be righted as quickly as possible. Such cases do not stand the shock of prolonged operations well.

Robinson declared that the chief etiology of volvulus sigmoid (this furnishes about sixty per cent of the locations) is elongated sigmoid, possessing a narrow foot, accompanied by inflammation caused by vigorous action of the left psoas muscle, which injures the sigmoid, inducing migration of germs or their products through the coats of the bowels, inciting plastic peritonitis. Adhesions follow, favoring the development of this mechanical obstruction. The cause back of all causes is intestinal decomposition, with infection by toxins. Man pays and pays for lack of control in eating--for food drunkenness.

Volvulus occurs in subjects over forty years of age. Marked tympanitis, or meteorism, or gas distention, is first located in the left iliac fossa. This may be remembered as a small, but not dependable, diagnostic point.