Sigmoid colon volvulus

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]

Sigmoid colon volvulus
Other namesSigmoid volvulus
SpecialtyGeneral surgery

Signs and symptoms

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  • 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

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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]

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

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  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

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References

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  1. ^ Balachandar, M. (2017). "Emergency Resection and Primary Anastamosis of Sigmoid Volvulus with Tube Caecostomy as a Temporary Decompression of Colon by Malecots Catheter" (PDF). New Indian Journal of Surgery. 8 (1): 47–48. doi:10.21088/nijs.0976.4747.8117.8. ISSN 0976-4747.
  2. ^ Sriram Bhat (2012). SRB's Manual of Surgery. JP Medical Ltd. p. 997. ISBN 9789350259443.
  3. ^ Jaypee Brothers (2007). Srb's Manual of Surgery by Bhat. Jaypee Brothers Publishers. p. 583. ISBN 9788180618475.
  4. ^ 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.
  5. ^ Scott C Thornton (November 30, 2015). "Sigmoid and Cecal Volvulus". Medscape. Retrieved June 13, 2016.
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