Description, Causes and Risk Factors:
Sigmoid volvulus occurs when the last part of the large bowel just before the rectum (the sigmoid shaped sigmoid colon) twists on its self. In the US sigmoid volvulus accounts for < 10% of intestinal obstruction cases. In Bolivian and Peruvian Andes, sigmoid volvulus accounts for 80% of obstruction cases. In US and Western Europe, sigmoid volvulus is associated with chronic constipation and laxative abuse. In developing countries, sigmoid volvulus is associated with diets high in vegetable fiber.
In the US, a long, redundant sigmoid colon - commonly seen in patients with illnesses such as Parkinson's disease (PD), multiple sclerosis (MS), spinal cord injuries, and psychiatric disorders - is the major cause of sigmoid volvulus. Inhibition of colonic motility by psychotropic medications as well as the possible inherent colonic dysmotility properties of the primary disease leads to sigmoid elongation. This redundant, enlarged bowel cause the approximation of 2 limbs of sigmoid colon and predisposes the limbs to twist around the mesenteric axis. Similarly, the patient with congenitally narrow sigmoid mesentery is predisposed to sigmoid volvulus due to increased mobility of the colon. Hirschsprung's disease affects the myenteric plexus of the colon also predisposes the patient to sigmoid volvulus.
Chronic constipation most often resulting from the low physical activity levels seen in resident of nursing care facilities, is also a cause of sigmoid volvulus secondary to sigmoid enlargement. Another important etiologic factor is the repetitive use of laxatives, cathartic agents, and enemas. The etiology of sigmoid volvulus in younger patients has been thought to be a congenital megasigmoid with additional stimuli such as purgation, diet, fecal loading, active peristalsis, or pregnancy.
Outside US, sigmoid volvulus may be caused by diet or infectious etiologies. Patients in non-industrialized countries often have high-residue diets that may results in overloading and enlargement of the sigmoid colon, prompting rotation around the root of the mesentery. The myenteric plexus of the bowel is affected by Chagas' disease, resulting in megacolon and predisposing the patient to sigmoid volvulus. Roundworm infestation is prevalent in more than 1 million people worldwide and causes sigmoid enlargement secondary to constipation.
Megacolon, large redundant sigmoid colon and excessively mobile colon.
It is more common in men.
The elderly (it is most common in those aged over 50 years but the next most commonly affected group is children).
Prevention of volvulus is basically a matter of preventing chronic constipation. A diet too high in high fibre diet would lead to elongation of the bowel, and large redundant sigmoid or mega colon.
Signs and symptoms may include:
Constipation versus absence of stools versus absence of flatus.
Nausea plus vomiting with consequent dehydration.
Abdominal tenderness with tympanitic distension.
Peritoneal signs, fever, tachycardia ischemia or infarction, 7% of patient present with gangrene.
Young patients may have recurrent attacks due to spontaneous torsion and detorsion.
Abrupt onset of severe, continuous crampy abdominal pain with colicky component due to peristalsis.
Differential diagnosis (DDx) may include:
Diverticular disease with sigmoid formation.
Distal small bowel obstruction.
Doctors may wish to do a combination of the following investigations to confirm the presence of a sigmoid volvulus:
Barium Enema: With a water soluble barium enema, the dilatation in the sigmoid colon can be demonstrated to be due to a twist, as it will show an area of complete obstruction with some twisting in the so called bird beak or bird of prey sign.
Colonoscopy could be done in rare cases, which would help to confirm diagnosis, as well as treating the obstruction.
X-ray: A normal plain abdominal x-ray will demonstrate a huge air filled distended bowel like the shape of an inverted U, with the convexity of the U facing the right upper abdominal quadrant. This shape has been described as the kidney bean shape, coffee bean shape, bent inner tube shape, ace of spades or `Omega loop Sign'.
Urgent hospital admission and treatment are required. Acute sigmoid volvulus is a surgical emergency. Any delay in treatment increases the risk of bowel ischemia, perforation, and fecal peritonitis.
If strangulation is not suspected:
Rectal tube placed beyond area of torsion (48-72 hrs) until bowel function resumes prevents immediate recurrence.
Elective sigmoid resection with primary anastomoses to prevent recurrence which is 50-90% in hours to weeks. Do a bowel prep. Recurrence after sigmoid resection is less than 3%.
If rigid sigmoidoscopy fails: Operative reduction. Unless necrosis is found, do not remove unprepped bowel due to increase risk of anastomotic leak. If necrosis is found on sigmoidoscopy then stop to prevent perforation. Perform Hartmann's procedure (sigmoid resection with end-descending colostomy and stapling of the rectal stump). Do reanastomosis later with bowel prep. If patient cannot tolerate elective resection then case reports of endoscopic sigmoidopexy (fix sigmoid to abdominal wall).
Rigid sigmoidoscopy reduces the volvulus 85-95% of time. Advance to 25-30 cm. Successful if meet a gush of air/stool. Use colonoscopy if volvulus beyond length of rigid scope. Flexible sigmoidoscope is not as good.
If strangulation is suspected (mortality of 30-60%): Do not use sigmoidoscope since perforation may occur. Perform lower anterior resection to remove affected segment.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
A new study from Brazil suggests that trendy intermittent fasting may be the reason for increasing insulin levels and the amount of abdominal fat. It also may lead to the damage of pancreatic cells. Intermitting fasting diet is a diet when a dieting person has “fast”...
It is well known that our overall health and wellbeing are totally dependable on what we eat. That is why a healthy diet plays a significant role in keeping the body healthy. Day after day, scientists all over the world make new discoveries proving that certain...
Quiz about this article
0 of 2 questions completed
Please answer on few questions to make our service more useful
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
0 of 2 questions answered correctly
Time has elapsed
You have reached 0 of 0 points, (0)
Question 1 of 2
Was this article useful for you?Correct
Thanks for your feedback!Incorrect
Thanks for your feedback!
Question 2 of 2
What else information about this disease you want to know ?Correct
Thanks for feedback!Incorrect
Thanks for feedback!
Good weather is the best reason to do outdoor sports, which will help not only lose weight, but also will strengthen health. Bicycle The sun dries out the local paths, so you can safely sit on your favorite bike and confidently twist the pedals, where the eyes look....read more
First aid for injuries consists of simple rules that need to be clearly implemented. If this is a closed injury, you need to immobilize the injured limb, otherwise the person may lose consciousness from a painful shock. If you need to get to the emergency room...read more
Many people spontaneously decide starting to do sport, while others weigh all the pros and cons for a log time. But almost all of them make the same mistakes, listening to the advice of non experts. There are 10 anti-tips for those who want to do plan to do some sport...read more