Sigmoid colon volvulus

• 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

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:

• Ogilvie syndrome
• Individuals with learning difficulties
• Chagas disease
• Hypothyroidism
• Anticholinergic drugs
• Multiple sclerosis
• Scleroderma
• Parkinson's disease

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.

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

• RT aspiration
• IV fluids
• Catheterisation
• Antibiotics
• By flatus tube or sigmoidoscope, derotation is done
• If derotation does not occur, then laparotomy through midline incision should be done. It is derotated manually. If viable, it can be fixed to lateral wall of abdomen or pelvis
• If sigmoid colon is gangrenous, then Hartmann's operation or Paul Mikulicz operation is done[4]