Respiratory distress and tracheal deviation secondary to sigmoid volvulus

Abstract

Introduction: The trachea is a semiflexible tube of 1.5 to 2 cm in width and 10 to 13 cm in length. Its deviation might be caused by not only diverse thoracic but also abdominal pathologies, which may compromise the airway. We present a case of a severe tracheal deviation due to an abdominal pathology causing displacement of mediastinal structures. Clinical Case: A 78-year-old woman presents with difficulty breathing. History of chronic bedridden and frequently constipated, last stool 5 days prior. On physical examination, cachectic complexion, dry mucous membranes, breathing superficially with scarce wheezing, SatO2 82% on room air. Abdomen distended with an absence of bowel sounds. Chest x-rays show severe tracheal deviation and abdominal x-ray with coffee bean sign. A laparotomy evidences a large sigmoid volvulus. A sigmoidectomy and descending colon colostomy is performed. Room air oxygen saturation improved after extubation to 96%. Conclusion: Desaturation and tracheal deviation were caused by a large sigmoid volvulus. Although these pathologies were thoracic, clinicians should suspect different underlying pathologies, in this case, abdominal.

Mediastinal and tracheal shift due to recurrent sigmoid volvulus: A case report

“…Generally speaking, external factors, such as intrathoracic conditions like tension pneumothorax and masses that exert pressure on the trachea and mediastinum, are commonly responsible for inducing tracheal deviation and mediastinal shift. 12 However, although uncommon, another possible cause for deviation could be the elevation of the diaphragm due to abdominal causes, as seen in the presented case.…”

“…CT scans allow for the examination of all tissues, including tumors, as well as the identification of reasons for displacement, skeletal and anatomical abnormalities, and other relevant factors. 12 …”