sigmoid colon volvulus
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| name = Sigmoid colon volvulus
| synonyms = Sigmoid volvulus
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| field = General surgery
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Sigmoid colon volvulus, also known as sigmoid volvulus, is volvulus affecting the sigmoid colon. It is a common cause of bowel obstruction{{Cite journal |last=Balachandar |first=M. |date=2017 |title=Emergency Resection and Primary Anastamosis of Sigmoid Volvulus with Tube Caecostomy as a Temporary Decompression of Colon by Malecots Catheter |url=https://journals.indexcopernicus.com/api/file/viewByFileId/487287.pdf |journal=New Indian Journal of Surgery |volume=8 |issue=1 |pages=47–48 |doi=10.21088/nijs.0976.4747.8117.8 |issn=0976-4747}} 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.{{cite book | title=SRB's Manual of Surgery | publisher=JP Medical Ltd | author=Sriram Bhat | year=2012 | isbn=9789350259443 | url=https://books.google.com/books?id=rfUfi_mmbskC&pg=PA997 | pages=997 }}
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:{{citation needed|date=May 2022}}
- 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.{{citation needed|date=May 2022}}
Diagnosis
- Plain X-ray (diagnostic in 70–80%): coffee bean sign is seen{{cite book | title=Srb's Manual of Surgery by Bhat | publisher=Jaypee Brothers Publishers | author=Jaypee Brothers | year=2007 | isbn=9788180618475 | url=https://books.google.com/books?id=JYss-QvCun4C&pg=PA583 | pages=583 }}
- Contrast enema: bird beak sign{{citation needed|date=May 2022}}
- CT scan: shows characteristic whirl pattern{{cite journal | title=Management of Colonic Volvulus | journal=Clin Colon Rectal Surg | year=2012 | volume=25 | issue=4 | pages=236–244 | doi=10.1055/s-0032-1329535 | pmc=3577612 | pmid=24294126 | author=Gingold D, Murrell Z}}
- Blood: haematocrit, renal functions, serum electrolytes{{citation needed|date=May 2022}}
Treatment
- 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{{cite web | url=http://emedicine.medscape.com/article/2048554-overview | title=Sigmoid and Cecal Volvulus | work=Medscape | date=November 30, 2015 | accessdate=June 13, 2016 | author=Scott C Thornton}}
References
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External links
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