Sigmoid colon volvulus

Sigmoid colon volvulus is a common cause of bowel obstruction and constipation. It is common in Asia, India (7% of intestinal obstruction) and especially South India because of the high fibre diet. It is very common cause of large bowel obstruction in Peru and Bolivia due to high altitude. The condition is more common in males and with old age. It is also common in patients with chronic constipation and laxative abuse.

It is common in:

• Ogilvie syndrome
• Individuals with learning difficulties
• Chaga's disease
• Hypothyroidism
• Anticholinergic drugs
• Multiple sclerosis
• Scleroderma
• Parkinson's disease

In sigmoid, volvulus rotation is always anticlockwise. It requires one and a half rotation to cause vascular obstruction and gangrene which eventually leads to perforation either at the root or at the summit of the sigmoid loop.

Clinical features

• Pain in abdomen – initially left-sided, eventually all over
• Absolute constipation
• Enormous distension of abdomen
• Late vomiting and eventually dehydration
• Features of peritonitis
• Hiccough and retching may occur
• Tyre-like feel of the abdomen is diagnostic

Investigation

1. Plain X-ray (diagnostic in 70-80%): coffee bean sign is seen
2. Contrast enema: bird beak sign
3. CT scan: shows characteristic whirl pattern
4. Blood: haematocrit, renal functions, serum electrolytes

Treatment

• RT aspiration
• IV fluids
• Catheterisation
• Antibiotics
• By flatus tube or sigmoidoscope, derotation is done
• If derotation does not occur, then laparotomy through midline incision should be done. It is derotated manually. If viable, it can be fixed to lateral wall of abdomen or pelvis
• If sigmoid colon is gangrenous, then Hartmann's operation or Paul Milulikz operation is done

References