Sigmoid colon volvulus
Sigmoid colon volvulus | |
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Other names | Sigmoid volvulus |
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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 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.[1]
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
- Hiccough 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:
- 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.
Diagnosis[]
- Plain X-ray (diagnostic in 70–80%): coffee bean sign is seen[2]
- Contrast enema: bird beak sign
- CT scan: shows characteristic whirl pattern[3]
- Blood: haematocrit, renal functions, serum electrolytes
Treatment[]
- RT aspiration
- IV fluids
- Catheterisation
- Antibiotics
- By flatus tube or sigmoidoscope, 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 operation is done[4]
References[]
- ^ Sriram Bhat (2012). SRB's Manual of Surgery. JP Medical Ltd. p. 997. ISBN 9789350259443.
- ^ Jaypee Brothers (2007). Srb's Manual of Surgery by Bhat. Jaypee Brothers Publishers. p. 583. ISBN 9788180618475.
- ^ 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.
- ^ Scott C Thornton (November 30, 2015). "Sigmoid and Cecal Volvulus". Medscape. Retrieved June 13, 2016.
External links[]
Classification |
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Categories:
- Human diseases and disorders
- Diseases of intestines