Acute volvulus of the sigmoid colon

Abstract

Fifty patients presenting with acute volvulus of the sigmoid colon have been analyzed. The diagnosis was made in 39 patients from the presenting features and abdominal radiographs. Deflation by sigmoidoscopy and flatus tube was performed in 19 patients with initial success in 15. Recurrent volvulus occurred in 6 of these patients. Laparotomy was carried out in 36 patients and colonie gangrene was present in 6 patients. The operative mortality rate was 42%. Mortality was related to a combination of age, intercurrent medical illness, and sepsis. Simple operative reduction was associated with a lower mortality when compared to resection but had a higher incidence of recurrent volvulus. This study supports the use of sigmoidoscopic reduction as the primary treatment of acute sigmoid volvulus. Laparotomy and colonic resection should be reserved for those patients who are medically fit and should ideally be performed on an elective basis after preliminary decompression. In unfit patients in whom sigmoidoscopic reduction fails, detorsion and colopexy is advocated.

Resection and primary anastomosis with or without modified blow-hole colostomy for sigmoid volvulus

“…Although the clinical manifestations of acute volvulus are often clearcut, a diagnostic dilemma is not uncommon. Sigmoid volvulus is the third most common cause of largebowel obstruction in the western world, after cancer and diverticular disease [1] . It accounts for 4% of all cases of large-bowel obstruction in the United States and United Kingdom [1,2] .…”

“…Sigmoid volvulus is the third most common cause of largebowel obstruction in the western world, after cancer and diverticular disease [1] . It accounts for 4% of all cases of large-bowel obstruction in the United States and United Kingdom [1,2] . Sigmoid volvulus is relatively more common in Eastern Europe, India and Africa, accounting for 50% of all cases of intestinal obstruction [1,2] .…”

“…It accounts for 4% of all cases of large-bowel obstruction in the United States and United Kingdom [1,2] . Sigmoid volvulus is relatively more common in Eastern Europe, India and Africa, accounting for 50% of all cases of intestinal obstruction [1,2] . The precise etiology of sigmoid volvulus remains speculative, and several etiological factors have been suggested including chronic constipation, high fiber diet, bowel habit, high altitude, and enemas containing ginger, pepper and herbal extracts [3] .…”

Sigmoid volvulus in young patients: Ą new twist on an old diagnosis

“…Above all, a sedentary lifestyle is a leading factor for the development of sigmoid volvulus. Sigmoid Volvulus is more common in older patients, and especially those with a psychiatric co-morbidity (14,15). Sigmoid volvulus is also seen in patients suffering from Parkinson's disease, Alzheimer's disease, pseudobulbar palsy, and chronic schizophrenia (3).…”

“…The classic coffee-bean sign on plain abdominal radiographs was found in 68.7% of patients encountered by Heis et al (17) and in 68.5% of patients encountered by Khanna et al (24). Javors et al (25) found that sigmoid volvulus was diagnosed with X-rays in 87% of patients while Welch and Anderson (14) found that it was similarly diagnosed in 83% of patients. Tiah et al (16) reported that sigmoid volvulus was diagnosed with plain abdominal radiography alone in 34.6% of cases.…”