Pdf sigmoid volvulus in the middle east researchgate. Sigmoid colon is characterized by torsion of the sigmoid loops of the colon, causing mechanical obstruction of the passage leading to the rectum and restriction of blood supply. Anatomic problems that increase a persons risk of developing sigmoid volvulus include. Fifty patients presenting with acute volvulus of the sigmoid colon have been analyzed. In sigmoid volvulus sv, the sigmoid colon wraps around itself and its mesentery. Feb 20, 2020 pathophysiology sigmoid volvulus occurs when an airfilled loop of the sigmoid colon twists about its mesentery. Sigmoid colon volvulus, also known as sigmoid volvulus, is volvulus affecting the sigmoid colon.
Sigmoid volvulus is the mostcommon form of volvulus of the gastrointestinal tract. Anatomic variation of the sigmoid colon in the pathogenesis of sigmoid volvulus in lilongwe, malawi. This diagnostic delay contributes to high morbidity and mortality. Synchronous volvulus of the sigmoid and transverse colon in a. Predictive accuracy of the sign was assessed in this study. Colonic obstruction due to sigmoid colon volvulus during pregnancy is a rare but complication with significant maternal and fetal mortality. Jul 23, 2015 this occurs in cases of longstanding chronic constipation where patients develop a large, elongated, relatively atonic colon, particularly in the sigmoid segment. Deflation by sigmoidoscopy and flatus tube was performed in 19 patients with initial success in 15.
A 53yearold man was admitted with a 2week history of bowel obstruction on a background of gradually worsening dyspeptic symptoms associated with vomiting and weight loss. Cecal volvulus however can go almost anywhere and can even be located in the pelvis. Endoscopic decompression, detorsion, and reduction of sigmoid. Results sigmoid volvulus is a leading cause of acute colonic obstruction in south america, africa, eastern europe and asia. Volvulus leads to acute bowel obstruction and can progress to strangulation, necrosis, and perforation. At present the incidence of obstruction due to volvulus is estimated at approximately 10%. Volvulus occurs most frequently in middleaged and elderly men. Redundant loop of sigmoid colon with narrow base of attachment of the mesosigmoid. Patients with sigmoid volvulus are often in the sixth to eighth decades of life and frequently have concomitant chronic illnesses, such as cardiac, pulmonary, and renal disease, that significantly influence their outcome. Mar 08, 2019 the frontline treatment for sigmoid volvulus is an emergent surgery to untwist the sigmoid. Prompt diagnosis of the volvulus sigmoid is critical to minimize fetal and maternal. Mild mucosal ischemic changes loss of vascular patterns, patchy erythema, edema, and erosions were noticed within the volvulus figure 4. We present a case of a 33yearold pregnant female in the third trimester with a sigmoid volvulus.
In sigmoid volvulus, a large sigmoid loop full of faeces and distended with gas twists on its mesenteric pedicle to. It remains a rare but important intestinal obstruction 1, 3. These features were suggestive of sigmoid volvulus. Full text full text is available as a scanned copy of the original print version. Cecal and sigmoid volvulus version 1 0 edit youtube. In the context sigmoid volvulus the colon may be described as having a coffee bean sign.
We describe a case of sigmoid volvulus in a patient with 33 weeks of gestation that developed complete necrosis of the left colon. The various signs described for sigmoid volvulus on plain radiograph and the sensitivity and specificity for these are given in table 1. Colonic volvulus is a common entity encountered by colorectal surgeons, but there are few reports of national data regarding postoperative outcomes. Sigmoid volvulus is one of the most common causes of large intestinal obstruction in developing countries and should be considered.
The area of intestine above the obstruction caused by the colon volvulus continues to function and fills with food, fluid and gas. This condition is more often encountered in the elderly. The pattern of presentation and management of 90 patients treated for sigmoid volvulus over a 7year period was studied. With age, this part of the colon or its attachments to the abdominal wall stretch out, allowing it to twist on itself, similar to the twisting of a long balloon, resulting in a volvulus. Sv accounts for 2% to 50% of all colonic obstructions and has an interesting. It is a common cause of bowel obstruction and constipation. A akinkuotu, jc samuel, n msiska, c mvula, ag charles 2011. Sigmoid volvulus involves torsion of a segment of bowel, often. The diagnosis was made in 39 patients from the presenting features and abdominal radiographs. Scribd is the worlds largest social reading and publishing site. An acute sigmoid volvulus is due to the torsion of the sigmoid colon around its mesenteric axis.
Sigmoid volvulus is a rare, but serious, complication that can occur during pregnancy. Sigmoid volvulus is a medical condition, in which the sigmoid colon practically twists on the sigmoid mesocolon. Recurrent volvulus occurred in 6 of these patients. Many cases have been treated successfully with noninvasive decompression techniques but again surgery is the recommended treatment due to a high recurrence rate in noninvasive procedures. Volvulus of the colon is primarily an afflication of older people. Jun 18, 2017 this feature is not available right now. These changes frequently lead to the large bowel obstruction. Ad, previous sigmoid volvulus treated with endoscopic detorsion. Transverse colonic volvulus after resection of sigmoid volvulus.
Aim this paper recognises visible or palpable emptiness of the left iliac fossa as a new clinical sign of sigmoid volvulus. To the authors knowledge there is a single pediatric case with metachronous sigmoid and transverse colon volvulus that was reported in 2000. Sigmoid volvulustwisting of the sigmoid colonaccounts for the majority of cases, with cecal volvulustwisting of the cecum and ascending colonoccurring less frequently. Sigmoid volvulus is a gastrointestinal condition that frequently leads to large bowel obstruction characterized by a twisted sigmoid colon. Intraoperatively, manual untwisting relieved the obstruction, and the distended hypertrophied sigmoid colon was decompressed by a tube passed. Sigmoid volvulus is thought to account for 25% of cases of largebowel obstruction in the united states, which places it third in prevalence after cancer and diverticulitis.
Pdf little is known about sigmoid volvulus in the middle east despite textbooks referring to the region as part of the volvulus belt. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Intestine volvulus an overview sciencedirect topics. The patient underwent an elective sigmoidectomy at a later date. Sigmoid volvulus describes the wrapping of the sigmoid colon around itself and its mesentery, causing an. The aim of this study was to describe the volvulus population, 30. Volvulus is the third most common cause of large bowel obstruction in the united states. Clinical practice guidelines for colon volvulus and acute. It is common in asia, india 7% of intestinal obstruction and especially south india because of the high fibre diet. Colon volvulus digestive diseases i ohio state medical center.
Methods 519 patients with acute abdomen of nontraumatic origin were. It is important because the resulting torsion of the mesentery may rapidly result in infarction and perforation of the bowel. It is estimated that, out of all large bowel obstructions, approximately 5% are due to the sigmoid volvulus. It is often referred to as acquired or idiopathic megacolon. Sigmoid volvulus is a common cause of obstruction worldwide.
Sigmoid volvulus is the commonest cause of large bowel obstruction in many regions of the world. Sigmoid volvulus is abnormal twisting of the sigmoid colon along its mesenteric axis that causes closedloop obstruction and can lead to ischemia, perforation, and death. G, ercp cannula and guidewire across the volvulus for endoscopic decompression and detorsion. A colon volvulus is an abnormal twisting of a portion of the gastrointestinal tract which can impair blood flow.
Megacolon and volvulus in parkinsons disease radiology. American society for gastrointestinal endoscopy guideline. Obstruction of the intestinal lumen and impairment of vascular perfusion occur when the degree of torsion exceeds 180 and 360 degrees, respectively 24. In the volvulus belt of africa and the middle east, 20%50% of bowel obstructions are a result of volvulus almost exclusively of the sigmoid colon. Thank you for your interest in spreading the word about the bmj. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Get a printable copy pdf file of the complete article 907k, or click on a page image below to browse page by page. Sigmoid volvulus sv, sigmoid kolonun kendisi ve mezenteri etraf. Apr 27, 2014 sigmoid volvulus cecal volvulus sigmoid volvulus can only move upwards and usually goes to the right upper quadrant. Volvulus is a common cause of large bowel obstruction but its metachronous occurrence is an extreme rarity.
Treatment of volvulus of the sigmoid colon and cecum jama. An observational study addressing the anatomic basis of mesosigmoidopexy as a rational treatment of nongangrenous sigmoid volvulus. Plain films reveal a distended kidney beanshaped loop of bowel in. Endoscopic reduction of a volvulus of the sigmoid colon in.
Patients with recurrent partial sigmoid volvulus are relatively asymptomatic or present with mild abdominal pain. The sigmoid colon is an sshaped part of the colon that is in the left lower side of the abdomen, above the rectum. Sigmoid volvulus is a cause of large bowel obstruction and occurs when the sigmoid colon twists on its mesentery, the sigmoid mesocolon. Detorsion of the volvulus was performed during colonoscopy. Large bowel volvulus accounts for 5% of all large bowel obstructions, with 60% of intestinal volvulus involving the sigmoid colon 6. Laparotomy was carried out in 36 patients and colonie gangrene. Volvulus can also arise as a rare complication in persons with redundant colon, a normal anatomic variation resulting in extra colonic loops. A small bowel resection and anastomosis must be performed in addition to correction of the colonic volvulus. Aug 02, 2017 sigmoid volvulus is a gastrointestinal condition that frequently leads to large bowel obstruction characterized by a twisted sigmoid colon. Sigmoid volvulus definition, symptoms, causes, treatment. Sigmoid volvulus emergency medicine jama jama network. Although volvulus of all individual segments of the colon has been reported, sigmoid volvulus is by far the most common, followed by cecal volvulus. Recurrent sigmoid volvulus associated with eventration of. Sigmoid volvulus vs cecal volvulus 1 a volvulus always extends away from the area of bowel twist.
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