DOI: http://dx.doi.org/10.18203/2349-2902.isj20200299

Sigmoid volvulus - an important cause of intestinal obstruction: how to deal with it?

Sujan Narayan Agrawal, Kamal Singh Kanwar

Abstract


Background: The objective of the study was to discuss the appropriate course of action in cases of sigmoid volvulus. It becomes important due to its high morbidity and mortality and its acute emergency presentation.

Methods: This is a retrospective study of sigmoid volvulus admitted in the department of surgery at Late SBRKM Government Medical College, Jagdalpur. The study period was from January 2017 to August 2019. A total of 27 cases were under study. On admission, they were examined, investigated and treated surgically and the outcome noted.

Results: Out of 27 patients 25 were male and 2 cases were female. The mean age group was 65 years. The co-morbidities consisted of previous abdominal surgeries, diabetes mellitus, hypertension, and renal complications. The common factor was chronic constipation and purgative abuse. All underwent a definitive surgical procedure like sigmoidectomy and colorectal anastamosis or sigmoidectomy and colostomy. In the second group colostomy closure and end to end anastamosis carried on at a later date. We have lost 5 patients in the post-operative period.

Conclusions: The sigmoid volvulus presents with the features of intestinal obstruction. The real danger is the gangrene of the bowel, as a consequence of ischaemia. It requires an early surgical intervention for the maximum benefit of the patient.


Keywords


Gangrenes of bowel, Intestinal obstruction, Ischaemia, Sigmoid volvulus

Full Text:

PDF

References


Raveenthiran V, Madiba TE, Atamanalp SS, De U. Volvulus of the sigmoid colon. Colorec Dis. 2010;12(7):1-7.

Arnold GJ, Nance FC. Volvulus of the sigmoid colon. Anna Surg. 1973;177(5):527-37.

Madiba TE, Thomson SR, Corr P. Volvulus of the sigmoid colon. Gastroenterol Forum. 1997;8:28-33.

Ballantyne GH, Brandner MD, Beart Jr RW, Ilstrup DM. Volvulus of the colon. Incidence and mortality. Ann Surg. 1985 Jul;202(1):83.

Atamanalp SS. Sigmoid volvulus. Eurasian J Medi. 2010;42(3):142.

Holder WD. Intestinal obstruction. Gastroenterol Clin North Am. 1988;17(2):317-340.

Sriram Bhat M. Sigmoid volvulus (volvulus of Pelvic colon). Sriram Bhat M, eds. SRB’s Manual of Surgery, 4rth ed. New Delhi, Jaypee Brothers medical publishers (P) Ltd; 2013: 997-1000.

Cirocchi R, Farinella E, La Mura F, Morelli U, Trastulli S, Milani D, et al. The sigmoid volvulus: surgical timing and mortality for different clinical types. World J Emerg Surg. 2010;5(1):1.

Sinha RS. A clinical appraisal of volvulus of the pelvic colon. With special reference to aetiology and treatment. Br J Surg. 1969;56(11):838-40.

Agrawal RL, Misra MK. Volvulus of the small intestine in Northern India. Am J Surg. 1970;120(3):366-70.

Saidi F. The high incidence of intestinal volvulus in Iran. Gut. 1969;10(10):838-41.

Waithe A. Intestinal obstruction in Rhodesian african. East Afr Med J. 1961;38:525-35.

Shepherd JJ. The epidemiology and clinical presentation of sigmoid volvulus. Br J Surg. 1969;56(5):353-9.

Taha SE, Suleiman SI. Volvulus of the sigmoid colon in the Gezira. Br J Surg. 1980;67(6):433-5.

Friedman JD, Odland MD, Bubrick MP. Experience with colonic volvulus. Dis Colon Rect. 1989;32(5):409-16.

Gibney EJ. Volvulus of the sigmoid colon. Surg Gynecol Obstet. 1991;173(3):243-55.

Madiba TE, Ramdial PK, Dada MA, Mokoena TR. Histological evidence of hypertrophy and ischaemia in sigmoid volvulus among Africans. East Afr Med J. 1999;76(7):381-4.

Grossmann EM, Longo WE, Stratton MD, Virgo KS, Johnson FE. Sigmoid volvulus in department of veterans affairs medical centers. Dis Colon Rect. 2000;43(3):414-8.

Tsushima GK, Fieshner PR. Colonic volvulus: imaging, diagnosis, and differential diagnosis. Seminars Colon Rectal Surg. 1999;10(3):139-44.

Burrell HC, Baker DM, Wardrop P, Evans AJ. Significant plain film findings in sigmoid volvulus. Clini Radiol. 1994;49(5):317-9.

Lau KC, Miller BJ, Schache DJ, Cohen JR. A study of large-bowel volvulus in urban Australia. Canad J Surg. 2006;49(3):203.

Ericksen AS, Krasna MJ, Mast BA, Nosher JL, Brolin RE. Use of gastrointestinal contrast studies in obstruction of the small and large bowel. Dis Colon Rect. 1990;33(1):56-64.

Coffee Bean Sign (Sigmoid Colon). Available at: https://radiopaedia.org/articles/coffee-bean-sign-sigmoid-colon. Accessed on 14 November 2019.

Brother TE, Strodel WE, Eckhauser FE. Endoscopy in colonic volvulus. Ann Surg. 1987;206(1):1-4.

Mangiante EC, Croce MA, Fabian TC, Britt LG. Sigmoid volvulus. A four-decade experience. Am Surg. 1989;55(1):41-4.

Khanna AK, Kumar P, Khanna R. Sigmoid volvulus. Dis Colon Rect. 1999;42(8):1081-4.

Atamanalp SS. Treatment of sigmoid volvulus: a single-center experience of 952 patients over 46.5 years. Techn Coloproctol. 2013;17(5):561-9.

Madiba TE, Thomson SR. The management of sigmoid volvulus. J Royal College Surg Edinburgh. 2000;45(2).

Coban S, Yilmaz M, Terzi A, Yildiz F, Ozgor D, Ara C, et al. Resection and primary anastomosis with or without modified blow-hole colostomy for sigmoid volvulus. World J Gastroenterol: WJG. 2008;14(36):5590.

Ören D, Atamanalp SS, Aydinli B, Yildirgan Mİ, Başoğlu M, Polat KY, et al. An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Colon Rectum. 2007;50(4):489-97.

Bhatnagar BN, Sharma CL. Nonresective alternative for the cure of nongangrenous sigmoid volvulus. Dis Colon Rectum. 1998;41(3):381-8.

Fleshman JL. Laparoscopic management of colonic volvulus. Semin Colon Rectal Surg. 1999;10:154-7.

Atamanalp SS, Ören D, Aydinli B, ÖZTÜRK G, Polat KY, Başoğlu M, et al. Elective treatment of detorsioned sigmoid volvulus. Turkish J Medi Scie. 2008 May 28;38(3):227-34.