Computed tomographic diagnosis of volvulus in intestinal. If untreated, sigmoid volvulus leads to bowel ischemia, perforation, sepsis, and potential death. Sigmoid volvulus is the most common form of volvulus of the gastrointestinal tract. Sigmoid volvulus emergency medicine jama jama network. Laparotomy showed a chronic sigmoid volvulus for which sigmoid colectomy was performed. Prompt diagnosis of the volvulus sigmoid is critical to minimize fetal and maternal. Sigmoid volvulus is the third most common cause of bowel obstruction after cancer and diverticulitis. Deflation by sigmoidoscopy and flatus tube was performed in 19 patients with initial success in 15. He notes that he has had occasional episodes of severe pain in llq similar to this but have resolved on there own. The sigmoid colon is an sshaped part of the colon that is in the left lower side of the abdomen, above the rectum. Predisposing factors to sigmoid volvulus include chronic constipation, megacolon and an excessively mobile colon. Diagnosis sigmoid volvulus discussion sigmoid volvulus represents a closed loop obstruction that can result in bowel ischemia. The incidence of transverse colon volvulus is relatively rare when compared to cecal volvulus and sigmoid volvulus. Sigmoid volvulus twisting of the sigmoid colonaccounts for the majority of cases, with cecal volvulus twisting of the cecum and ascending colonoccurring less frequently.
Pdf a case of transverse colon volvulus after sigmoid. Users may download, print and share this work on the internet for noncommercial purposes only, provided the original work is properly cited, and. In addition, synchronous volvulus of the sigmoid and cecum,2 or sigmoid and ileum may occur. Sigmoid volvulus is the most common, accounting for 60% of cases of intestinal volvulus 2. An acute sigmoid volvulus is due to the torsion of the sigmoid colon around its mesenteric axis. Endoscopic decompression, detorsion, and reduction of sigmoid. Sigmoid volvulus is a gastrointestinal condition that frequently leads to large bowel obstruction characterized by a twisted sigmoid colon. Files are available under licenses specified on their description page. Sigmoid volvulus is thought to account for 25% of cases of largebowel obstruction in the united states, which places it third in prevalence after cancer and diverticulitis. Full text full text is available as a scanned copy of the original print version. In sigmoid volvulus sv, the sigmoid colon wraps around itself and its mesentery. In december, 1912, i reported a study of 191 cases of intestinal obstruction, exclusive of external hernia.
Any delay in treatment increases the risk of bowel ischaemia, perforation and faecal peritonitis. Treatment of volvulus of the sigmoid colon and cecum. Sigmoid volvulus definition, symptoms, causes, treatment. Sigmoid volvulus 1 joseph junewick, md facr 04072012 history 12 year old male with recurrent abdominal pain. Sigmoid volvulustwisting of the sigmoid colonaccounts for the majority of cases, with cecal volvulustwisting of the cecum and ascending colonoccurring less frequently. Endoscopic decompression, detorsion, and reduction of. For about two years before he had experienced intermittent abdominal pain, distension and constipation. Unusual occurrence of sigmoid volvulus in a young adult. In the context sigmoid volvulus the colon may be described as having a coffee bean sign. Sigmoid volvulus is abnormal twisting of the sigmoid colon along its mesenteric axis, that causes closedloop obstruction and can lead to bowel ischemia and perforation. A transverse colon volvulus was found, and an extended right. The main approach for the treatment of sigmoid volvulus is the insertion of a rectal tube. Typical radiographic findings of this condition include the coffee bean sign, showing the presence of a ushaped, distended sigmoid colon. Management of sigmoid volvulus avoiding sigmoid resection ncbi.
Aug 02, 2017 sigmoid volvulus is a gastrointestinal condition that frequently leads to large bowel obstruction characterized by a twisted sigmoid colon. Epidemiology large bowel volvulus accounts for 5% of all large bowel obstructions, with 60% of intestinal. A 43yearold male developed seronegative polyarthritis after a short attack of diarrhoea. Sigmoid volvulus is more common than volvulus of the cecum and tends to occur in an older age group. Redundant loop of sigmoid colon with narrow base of attachment of the mesosigmoid. Sigmoid volvulus cecal volvulus sigmoid volvulus can only move upwards and usually goes to the right upper quadrant. Radiographic features are specific to the distinct types of volvulus, but on ct they generally demonstrate the whirl sign. Determine the frequency of sigmoid colon volvulus, describe clinical and paraclinical signs. Anatomic problems that increase a persons risk of developing sigmoid volvulus include. Feb 20, 2020 pathophysiology sigmoid volvulus occurs when an airfilled loop of the sigmoid colon twists about its mesentery. It typically occurs in elderly, debilitated persons. This video demonstrates the endoscopic treatment of a sigmoid volvulus.
In the us sigmoid volvulus accounts for sigmoid volvulus accounts for 80% of. Sigmoid volvulus is the twisting of the sigmoid colon of the large intestine. Volvulus in the pediatric population commonly occurs in the small bowel associated with malrotation or internal hernia whereas sigmoid volvulus sv is extremely rare. It is usually an acquired condition seen in patients with chronic constipation who abuse laxatives but it is. The computed tomographic appearance of volvulus in intestinal malrotation in an adult is presented.
Sigmoid volvulus is the mostcommon form of volvulus of the gastrointestinal tract. Flexible sigmoidoscopy is commonly performed for the confirmation and initial management of sigmoid volvulus, however the utility of endoscopic therapy in acute caecal volvulus diagnosis and treatment is generally considered limited, 2 as the success rate of colonoscopic reduction of caecal volvulus has been about 30%. If the file has been modified from its original state, some details such as the timestamp may not fully reflect those of the original file. After re duction of the volvulus, the distance between the sigmoidrectal junction and the sigmoid descending colon junction was widened by dissecting the meso. The patient was a 68yearold man who underwent sigmoidectomy for. Patients with sigmoid volvulus are often in the sixth to eighth decades of life and frequently have concomitant chronic illnesses, such as cardiac, pulmonary, and renal disease, that signi. Cecal and sigmoid volvulus version 1 0 edit youtube. The patient underwent an elective sigmoidectomy at a later date. Sigmoid volvulus involves torsion of a segment of bowel, often. All structured data from the file and property namespaces is available under the creative commons cc0 license. Many cases have been treated successfully with noninvasive decompression techniques but again surgery is the recommended treatment due to a high recurrence rate in noninvasive procedures. Diagnosis and treatment of caecal volvulus postgraduate. Volvulus occurs most frequently in middleaged and elderly men.
It remains a rare but important intestinal obstruction 1, 3. Jun 18, 2017 this feature is not available right now. The medical history included ischemic cardiomyopathy and a previous sigmoid volvulus, treated with. Plain radiographs were suggestive of a large bowel obstruction due to volvulus. Its prevalence among patients who present with acute intestinal obstruction varies geographically, ranging from fewer than 10% in the us to as high as 80% of cases from the bolivian and peruvian andes. The most common sites of volvulus are the sigmoid colon and cecum. Below are the links to the authors original submitted files for images.
Sigmoid volvulus is particularly common in elderly persons. It is the most common intestinal volvulus and is an absolute medical and surgical emergency. Journal of the college of physicians and surgeons pakistan 2014, vol. Recurrent volvulus occurred in 6 of these patients. Sigmoid volvulus occurs when the last part of the large bowel just before the rectum the sigmoid shaped sigmoid colon twists on its self. Sigmoid volvulus is one of the most common causes of large intestinal obstruction in developing countries and should be considered. Most patients give a long history of poor bowel habits and chronic constipation with frequent use of cathartics. Jan 05, 2016 sigmoid volvulus is the most common form of volvulus of the gastrointestinal tract. This file contains additional information such as exif metadata which may have been added by the digital camera, scanner, or software program used to create or digitize it. We present a case of a 33yearold pregnant female in the third trimester with a sigmoid volvulus. Keller medical corps, army of the united states volvulus of the sigmoid is an infrequent but often spectacular cause of acute or intermittent in testinal obstruction.
Sigmoid colon is characterized by torsion of the sigmoid loops of the colon, causing mechanical obstruction of the passage leading to the rectum and restriction of blood supply. Recurrence after sigmoidoscopy detorsion was detected in 6 21. Sigmoid colon volvulus, also known as sigmoid volvulus, is volvulus affecting the sigmoid colon. Intestinal volvulus is a broad term that describes the torsion of bowel around its mesentery. Radiographic findings that may be diagnostic of sigmoid volvulus include a large airfilled bowel loop, which represents the sigmoid colon, arising from the pelvis and extending cranially beyond the level of the transverse colon the northern exposure sign figs 1823 10,15. It is a common cause of bowel obstruction and constipation. Sigmoid volvulus is an important underlying cause of intestinal obstruction, which usually causes continuous and severe abdominal pain.
Get a printable copy pdf file of the complete article 907k, or click on a page image below to browse page by page. Sigmoid volvulus description, causes and risk factors. Review open access endoscopic reduction of a volvulus of. Sv accounts for 2% to 50% of all colonic obstructions and has an interesting. Patients present with abdominal pain, distention, and absolute constipation.
The key difference between the sigmoid and cecal volvulus is the site of the volvulus or twist in the bowel. Sigmoid volvulus occurs when a redundant loop rotates around its elongated mesentery. In the us sigmoid volvulus accounts for jul 23, 2015 acute sigmoid volvulus is a surgical emergency. This article is from world journal of emergency surgery.
Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Cecal volvulus is much more uncommon than sigmoid volvulus and rarely can be addressed colonoscopically. Obstruction of the intestinal lumen and impairment of vascular perfusion occur when the degree of torsion exceeds 180 and 360 degrees, respectively 24. Fifty patients presenting with acute volvulus of the sigmoid colon have been analyzed. Thirtyeight patients having 44 episodes of sigmoidal volvulus were treated in a 50bed hospital in northern iran over an eightandonehalfyear period. Sigmoid volvulus is a rare, but serious, complication that can occur during pregnancy. Volvulus can also arise as a rare complication in persons with redundant colon, a normal anatomic variation resulting in extra colonic loops. It is important to understand that the acute sigmoid volvulus is a medical emergency and that it should be treated as such. Sigmoid volvulus is a cause of large bowel obstruction and occurs when the sigmoid colon twists on its mesentery, the sigmoid mesocolon. Laparotomy was carried out in 36 patients and colonie. It is a very common cause of large bowel obstruction in peru and bolivia due to high altitude. Duration of the previous laparotomy varied from a week to 10 years. Sigmoid volvulus is the commonest cause of large bowel obstruction in many regions of the world. The smallbowel loops encircling the superior mesenteric artery create a whirllike pattern that may be distinctive for this diagnosis.
Sigmoid volvulus is abnormal twisting of the sigmoid colon along its mesenteric axis that causes closedloop obstruction and can lead to ischemia, perforation, and death. Arthritis with sigmoid volvulus and hla b27 rheumatology. Case presentation o 20 yo male with abdominal distention, nausea and 1 episode of emesis o passed flatus one day prior to admission. A 79yearold man with cortical cerebellar atrophy presented to the gastroenterology department with a 7day history of progressive abdominal distention and constipation. Full text get a printable copy pdf file of the complete article 1.
A colon volvulus is an abnormal twisting of a portion of the gastrointestinal tract which can impair blood flow. With age, this part of the colon or its attachments to the abdominal wall stretch out, allowing it to twist on itself, similar to the twisting of a long balloon, resulting in a volvulus. Detorsion of the volvulus was performed during colonoscopy. Apr 27, 2014 sigmoid volvulus cecal volvulus sigmoid volvulus can only move upwards and usually goes to the right upper quadrant. Sigmoid volvulus vs cecal volvulus 1 a volvulus always extends away from the area of bowel twist. Pdf sigmoid volvulus in the middle east researchgate. He had a history of chronic constipation due to neurogenic bowel dysfunction. Sigmoid volvulus in children even though rare might also be amenable to correction by colonoscopy. These features were suggestive of sigmoid volvulus.
The decompression of the sigmoid volvulus can be guided through endoscopy or fluoroscopy. Plain films reveal a distended kidney beanshaped loop of bowel in. The sigmoid volvulus is an acute strangulation of the colon by the twisting of the sigmoid loop around its mesenteric axis resulting in partial or complete obstruction of the colonic lumen. An observational study addressing the anatomic basis of mesosigmoidopexy as a rational treatment of nongangrenous sigmoid volvulus. An 80yearold man who was receiving palliative treatment for metastatic head and neck cancer presented with abdominal distension and pain. A akinkuotu, jc samuel, n msiska, c mvula, ag charles 2011. Sep 22, 2008 a 75year old male presented to the emergency room with worsening abdominal pain and distension. Cecal volvulus however can go almost anywhere and can even be located in the pelvis. Abstractsigmoid volvulus is a rare, but serious, complication that can occur during. Anatomic variation of the sigmoid colon in the pathogenesis of sigmoid volvulus in lilongwe, malawi. Since that time i have added to the original group the records of 66 cases of intestinal obstruction, making. Sigmoid volvulus medigoo health medical tests and free. The area of intestine above the obstruction caused by the colon volvulus continues to function and fills with food, fluid and gas. Colonic volvulus is a loop of bowel twisted around the site of mesenteric attachment leading to bowel obstruction.
Nonoperative decompression, elective resection and anastomosis, primary resection and anastomosis, and obstructive resection were used in treatment of these. The possible influence of diet on the high incidence of this disease is discussed. The sigmoid colon is involved in a majority of these cases. It is common in asia, india 7% of intestinal obstruction and especially south india because of the high fibre diet.
Torsion results in narrowing of the lumen at the point of rotation and compromise of the vessels that supply the torted gut. Surgical management of sigmoid volvulus maria georgiades, md october 18, 2012. There was no evidence of hemodynamic instability or peritonitis on examination. Endoscopic reduction of a volvulus of the sigmoid colon in.
Management of sigmoid volvulus based on ladds procedure. Volvulus of the transverse colon is very rare, especially its occurrence after sigmoid resection for sigmoid colon volvulus. Cecal volvulus takes place due to the torsion caused in the cecum area. Clinical practice guidelines for colon volvulus and acute. Sv accounts for 2% to 50% of all colonic obstructions and has an interesting geographic dispersion. The majority of patients can be successfully treated with nonoperative decompression but elective definitive surgery has been recommended in view of the high recurrence rate over 60% and the risks. Volvulus refers to torsion of a segment of the alimentary tract, which often leads to bowel obstruction. Colon volvulus digestive diseases i ohio state medical center. The sigmoid volvulus is the twist that takes place in the sigmoid colon. Volvulus of other portions of the alimentary tract, such as the stomach, gallbladder, small bowel, splenic flexure, and transverse colon, are rare. It mainly occurs in elderly patients and represents an abdominal emergency requiring urgent treatment. An attempt to detorse the volvulus and decompress the colon endoscopically failed, after which the patient was taken for an exploratory laparotomy. The frontline treatment for sigmoid volvulus is an emergent surgery to untwist the sigmoid. Intestine volvulus an overview sciencedirect topics.
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