Sigmoid colon volvulus

Sigmoid colon volvulus
Other names	Sigmoid volvulus
Specialty	General surgery

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]

Signs and symptoms[edit]

• 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[edit]

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]}

• 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]}

Diagnosis[edit]

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

Treatment[edit]

• 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^[5]

References[edit]

External links[edit]