Sigmoid colon volvulus

Sigmoid colon volvulus, also known as sigmoid volvulus, is volvulus affecting the sigmoid colon. It is a common cause of bowel obstruction[1] and constipation. It is common in Asia, India (7% of intestinal obstruction) and especially South India because of the high fibre diet. It is a very common cause of large bowel obstruction in Peru and Bolivia due to high altitude.[2]

Sigmoid colon volvulus
Other namesSigmoid volvulus
SpecialtyGeneral surgery

Signs and symptoms

  • Pain in abdomen – initially left-sided, eventually all over
  • Absolute constipation
  • Enormous distension of abdomen
  • Late vomiting and eventually dehydration
  • Features of peritonitis
  • Hiccup and retching may occur
  • Tyre-like feel of the abdomen is diagnostic

Cause

The condition is more common in males and with old age. It is also common in people with chronic constipation and laxative abuse.

It is common in:

In sigmoid, volvulus rotation is always anticlockwise. It requires one and a half rotation to cause vascular obstruction and gangrene which eventually leads to perforation either at the root or at the summit of the sigmoid loop.

Diagnosis

  1. Plain X-ray (diagnostic in 70–80%): coffee bean sign is seen[3]
  2. Contrast enema: bird beak sign
  3. CT scan: shows characteristic whirl pattern[4]
  4. Blood: haematocrit, renal functions, serum electrolytes

Treatment

References

  1. Balachandar, M. (2017). "Emergency Resection and Primary Anastamosis of Sigmoid Volvulus with Tube Caecostomy as a Temporary Decompression of Colon by Malecots Catheter" (PDF). New Indian Journal of Surgery. 8 (1): 47–48. doi:10.21088/nijs.0976.4747.8117.8. ISSN 0976-4747.
  2. Sriram Bhat (2012). SRB's Manual of Surgery. JP Medical Ltd. p. 997. ISBN 9789350259443.
  3. Jaypee Brothers (2007). Srb's Manual of Surgery by Bhat. Jaypee Brothers Publishers. p. 583. ISBN 9788180618475.
  4. Gingold D, Murrell Z (2012). "Management of Colonic Volvulus". Clin Colon Rectal Surg. 25 (4): 236–244. doi:10.1055/s-0032-1329535. PMC 3577612. PMID 24294126.
  5. Scott C Thornton (November 30, 2015). "Sigmoid and Cecal Volvulus". Medscape. Retrieved June 13, 2016.
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