From the Research
Introduction to Sigmoid Volvulus
Sigmoid volvulus is a gastrointestinal condition characterized by the twisting of the sigmoid colon, leading to obstruction and potentially severe complications 1. This condition is associated with various factors, including advanced age, constipation, and the use of certain medications.
Causes and Risk Factors
The causes of sigmoid volvulus are multifactorial, with colonic length being a significant predisposing factor 2. Other risk factors include:
- Advanced age
- Constipation [(1,3,4)]
- Chronic fecal impaction
- Psychiatric disorders
- Colonic dysmotility
- Prior abdominal surgical procedures
- Diabetes
- Hirschsprung's disease
Preventive Measures
Effective management of constipation is crucial in preventing the recurrence of sigmoid volvulus 1. This can be achieved through:
- Dietary changes
- Increased fluid intake
- Regular exercise
- Medications to manage constipation
Signs and Symptoms
The clinical manifestations of sigmoid volvulus vary with disease progression but typically present with a triad of:
- Constipation
- Progressive abdominal distension
- Severe abdominal pain 2
Diagnosis
Diagnosis of sigmoid volvulus can be made using:
- Plain-film x-ray studies, which may demonstrate a "coffee bean" or "omega loop" sign
- Computed tomography, which may show the "whirl" sign 2
- Endoscopy
Treatment
Treatment of sigmoid volvulus depends on the severity of the condition and may include:
- Endoscopic detorsion, which is preferred for patients without signs of peritonitis or colonic gangrene 4
- Elective surgical intervention, which may involve detorsion with colopexy or resection of the sigmoid colon [(5,2)]
- Exploratory laparotomy, which is mandatory if complications such as bowel gangrene occur 2
Treatment Options and Dosing
There is no specific dosing information available for the treatment of sigmoid volvulus. However, the treatment options may include:
- Endoscopic detorsion, which can be performed using a flexible colon fiberscope
- Surgical intervention, which may involve the use of a 25-mm circular stapler for re-anastomosis 5
Differentials and Caveats
It is essential to consider sigmoid volvulus as a rare but important cause of abdominal pain in young and otherwise healthy patients [(4,2)]. A delay in diagnosis and treatment can lead to colonic necrosis, amplifying the associated morbidity and mortality. Swift intervention is imperative to mitigate these complications and attain a conclusive remedy.