Symptoms of Sigmoid Volvulus
The classic triad of symptoms in sigmoid volvulus includes abdominal pain, constipation, and abdominal distension, with vomiting appearing as a late sign. 1
Primary Clinical Presentation
- Abdominal pain - typically progressive and can be severe 1
- Constipation - often complete obstipation 1
- Abdominal distension - often massive and asymmetric 1
- Vomiting - appears as a late sign in the disease course 1
- Previous episodes of abdominal distention reported in 30-41% of cases 1
Physical Examination Findings
- Abdominal distension - often pronounced and asymmetric 1
- Diminished bowel sounds - due to colonic obstruction 1
- Empty rectum on digital examination - a characteristic finding 1
- Asymmetric gaseous abdominal distention with emptiness of the left iliac fossa - considered pathognomonic for sigmoid volvulus, though challenging to detect 1
Timing and Progression
- Symptom duration typically ranges from a few hours to several days 1
- In Western countries, patients usually present 3-4 days after symptom onset 1
- In "volvulus belt" countries (parts of Africa, Middle East, South America), presentation may be more acute with peritonitis and shock 1
Variations in Presentation
- The classic triad (pain, constipation, distension) is more common in endemic volvulus (88%) compared to sporadic cases (33%) 1
- Typical patient profile in Western countries: elderly, institutionalized, and taking psychotropic medications that cause chronic constipation 1
- Patients with mental illness and chronic constipation are at higher risk 2
- Patients may have a personal history of previous sigmoid volvulus episodes in 30-40% of cases 1
Warning Signs of Complications
- Signs of peritonitis or shock suggest colonic necrosis or perforation 1
- Silent abdomen is the most valuable indicator of gangrenous bowel 2
- Absence of peritoneal signs does not rule out bowel ischemia 1
- Patients may develop renal insufficiency due to vomiting and dehydration 1
Diagnostic Pitfalls
- History may be unreliable in patients with neuropsychiatric issues 1
- Sigmoid volvulus can be misdiagnosed as fecal impaction, especially in younger patients 3
- The condition can occur in any age group, including young adults, though it's more common in the elderly (mean age 70 years) 4
- Abdominal examination may be difficult due to massive distension 1
Risk Factors for Recurrence
- Sigmoid distension of more than 9 cm on initial CT is associated with increased risk of recurrence 4
- Without definitive surgical management, recurrence rates are extremely high (45-71%) 5
Understanding these symptoms is critical for early diagnosis and intervention, as delayed treatment can lead to bowel ischemia, perforation, and significantly increased mortality rates 1, 5.