The Twisted Colon: A Review of Sigmoid Volvulus

In sigmoid volvulus (SV), the sigmoid colon wraps around itself and its mesentery. Sigmoid volvulus accounts for 2% to 50% of all colonic obstructions and has an interesting geographic dispersion. SV generally affects adults, and it is more common in males. The etiology of sigmoid volvulus is multifactorial and controversial; the main symptoms are abdominal pain, distention, and constipation, while the main signs are abdominal distention and tenderness. Routine laboratory findings are not pathognomonic: Plain abdominal X-ray radiographs show a dilated sigmoid colon and multiple small or large intestinal air-fluid levels, and abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy shows a spiral sphincter-like twist of the mucosa. The diagnosis of sigmoid volvulus is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definative or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful nonoperative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%. Journal of Surgical Sciences (2019) Vol. 23(2): 90-94

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Operative Management and Outcomes of Patients with Sigmoid Volvulus at a Tertiary Public Hospital in Malawi

Annals of African Surgery ◽

10.4314/aas.v18i3.9 ◽

2021 ◽

Vol 18 (3) ◽

pp. 176-179

Author(s):

Ephraim Bitilinyu-Bangoh ◽

Fatsani Mwale ◽

Loveness Ulunji Chawinga ◽

Gift Mulima

Keyword(s):

Hospital Stay ◽

Anastomotic Leakage ◽

Primary Anastomosis ◽

Length Of Hospital Stay ◽

Operative Management ◽

Sigmoid Resection ◽

Sigmoid Volvulus ◽

Hartmann’S Procedure ◽

Hartmann's Procedure ◽

Kamuzu Central Hospital

Background: Sigmoid Volvulus (SV) is a common cause of acute bowel obstruction in Malawi. We aimed to describe the surgical management of SV and its outcomes at Kamuzu Central Hospital, Lilongwe, Malawi. Methods: We retrospectively reviewed records from January 2019 to December 2019 of all SV patients, aged 18 years and above. Data extracted included age, sex, admission date, surgery date, bowel viability at time of surgery, procedure done, suspected anastomotic leakage, length of hospital stay and mortality. The data was analyzed using STATA 14.0. Results: There were more males (n= 59, 81.9 %) than females. The median (IQR) age was 50.5 (38-60) years. A viable sigmoid colon was present in 61 (84.7%) patients. The commonest procedures done were sigmoid resection and primary anastomosis (RPA) (59.7%, n=43) and Hartmann’s procedure (HP) (36.1%, n=26). The median length of hospital stay was 5 days in HP, 7 days in RPA and longest in mesosigmoidopexy (10 days). Suspected anastomotic leakage occurred in 2(4.7%) patients. The overall mortality was 6.9% with all deaths occurring in RPA patients. Conclusion: Mortality is high in SV patients who undergo RPA. We recommend Hartmann’s procedure in cases where the bowel has significant oedema or is gangrenous.

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A Symptomatic Coffee Bean: Acute Sigmoid Volvulus

Case Reports in Gastroenterology ◽

10.1159/000475918 ◽

2017 ◽

Vol 11 (2) ◽

pp. 348-351 ◽

Cited By ~ 6

Author(s):

Michael Scharl ◽

Luc Biedermann

Keyword(s):

Sigmoid Colon ◽

Guide Wire ◽

Outlet Obstruction ◽

Primary Treatment ◽

Sigmoid Volvulus ◽

Coffee Bean ◽

Diagnostic Colonoscopy ◽

X Ray ◽

Abdominal Emergency ◽

Distended Abdomen

An acute sigmoid volvulus is due to the torsion of the sigmoid colon around its mesenteric axis. It mainly occurs in elderly patients and represents an abdominal emergency requiring urgent treatment. A 53-year-old male patient with severe craniocerebral injury and traumatic subarachnoidal bleeding 3 weeks prior presented on the ward with distended abdomen without abdominal pain, muscular defense, or resistances. He featured large volume diarrhea within the last few hours without signs of bleeding. A plain abdominal X-ray demonstrated a coffee bean sign indicating a sigmoid volvulus. A consequent CT scan of the abdomen revealed a deep outlet obstruction with massively dilated, elongated and twisted loop of the sigmoid colon and no signs of perforation. We performed emergency colonoscopy under the assumption of an acute sigmoid volvulus. After careful insertion of the endoscope completely refraining from insufflation of air or CO2, endoscopic reposition of the sigma could be achieved and a colonic drainage was placed over an inserted guide wire up to the proximal transverse colon. No relapse occurred and a diagnostic colonoscopy after 4 weeks revealed no tumor or polyps. Our report describes a classic case of acute sigmoid volvulus and undermines the potential of colonoscopy as conservative primary treatment of choice.

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Article Commentary: The Twisted Colon: A Review of Sigmoid Volvulus

The American Surgeon ◽

10.1177/000313481207800331 ◽

2012 ◽

Vol 78 (3) ◽

pp. 271-279 ◽

Cited By ~ 21

Author(s):

Stephen B. Osiro ◽

Debbie Cunningham ◽

Mohammadali M. Shoja ◽

R. Shane Tubbs ◽

Jerzy Gielecki ◽

...

Keyword(s):

Controlled Trial ◽

Primary Anastomosis ◽

Sigmoid Resection ◽

Sigmoid Volvulus ◽

Mortality Data ◽

Abdominal Radiography ◽

Plain Abdominal Radiography ◽

Confirmatory Tests ◽

Sporadic Cases ◽

Tomography Scan

Sigmoid volvulus (SV) is the third leading cause of colon obstruction in adults. In infants and children, it is exceedingly rare with only sporadic cases reported so far. SVs from secondary causes, with congenital megacolon being the most important, are nevertheless more common in young people. The etiology of this disorder is not completely understood. It is known to occur in the setting of redundant sigmoid loop, which rotates around its narrow and elongated mesentery. Although the latter occurs in the setting of constipation, a congenitally elongated colon, and other predisposing factors, there is no consensus on the precipitating factor leading to SV formation. The symptoms are suggestive of small bowel obstruction, but the presentations can be acute or indolent. Plain abdominal radiography is used to diagnose SV in most cases with computed tomography scan or magnetic resonance imaging as the confirmatory tests when necessary. After it has been untwisted, the definitive and standard therapy for SV is sigmoid resection and primary anastomosis. The nonresective alternatives have also been widely used with mixed success, but a large, randomized controlled trial is needed to compare their efficacy with resection and primary anastomosis. Laparoscopic surgery in SV management is unwarranted and costly. Complications of SV include hemorrhagic infarction, perforation, septic shock, and death. The mortality data from SV vary, but the latest literature cites an overall range of 14 to 45 per cent.

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Is single-stage resection and anastomosis for acute sigmoid volvulus, without intra operative colonic lavage a safe procedure?

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.06.6017 ◽

2021 ◽

Vol 28 (06) ◽

pp. 872-875

Author(s):

Muhammad Bilal ◽

Viqar Aslam ◽

Waqas Jan ◽

Zaheer Udin

Keyword(s):

Primary Anastomosis ◽

Mechanical Bowel Preparation ◽

Sigmoid Volvulus ◽

Single Stage ◽

Safe Procedure ◽

Local Data ◽

Cross Sectional ◽

Female Ratio ◽

Colonic Lavage ◽

Resection And Anastomosis

Objective. This study was conducted to provide local data regarding the results and post-operative complications after single-stage resection and anastomosis for acute sigmoid volvulus, without intra operative colonic lavage. Study Design: Descriptive Cross Sectional. Setting: DHQ Charsadda. Period: May 2017 to December 2019. Material & Methods: This clinical study was done on 50 patients who presented with the signs and symptoms of acute sigmoid volvulus excluding those with complications of the illness such as gangrene, perforation and peritonitis. Surgery for all patients was carried out under General anaesthesia. All the patients underwent emergency resection and primary anastomosis, without mechanical bowel preparation. Data were collected regarding post operation complication and analysis by using SPSS version 23. Chi square test was used to compare at level of significance <0.005. Results: Median age of patients was 50 years with male to female ratio 5:3. Seven patients presented with wound infection, one dehiscence while zero Anastomotic leakage and zero death postoperative recorded. Conclusion: Single stage resection and primary anastomosis without preoperative colonic lavage for acute sigmoid volvulus is a simpler and short procedure with low mortality and morbidity rates.

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Sigmoid volvulus: Comorbidity with sigmoid gangrene

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.1.295 ◽

2019 ◽

Vol 35 (1) ◽

Cited By ~ 1

Author(s):

Sabri Selcuk Atamanalp ◽

Esra Disci ◽

Refik Selim Atamanalp

Keyword(s):

Open Access ◽

Mortality Rate ◽

Sigmoid Colon ◽

Emergency Surgery ◽

Original Work ◽

Clinical Laboratory ◽

Sigmoid Volvulus ◽

Creative Commons ◽

Open Access Article

Sigmoid volvulus (SV) is the wrapping of the sigmoid colon around its mesentery, and sigmoid gangrene is a catastrophic complication of SV. Although the diagnosis of SV is generally not difficult, unfortunately, most of the clinical, laboratory and radiological signs are not pathognomonic in demonstrating sigmoid gangrene. The treatment of gangrenous SV requires emergency surgery. Sigmoid gangrene worsens the prognosis of SV by doubling the mortality rate. How to cite this:Atamanalp SS, Disci E, Atamanalp RS. Sigmoid volvulus: Comorbidity with sigmoid gangrene. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.295 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Sigmoid Resection and Primary Anastomosis Without Any Diversion or Exteriorization for Impacted Foreign Body in Sigmoid Colon

KYAMC Journal ◽

10.3329/kyamcj.v10i4.45723 ◽

2020 ◽

Vol 10 (4) ◽

pp. 214-218

Author(s):

ABM Moniruddin ◽

M Fardil Hossain Faisal ◽

Salma Chowdhury ◽

Tanvirul Hasan ◽

Romana Rafique ◽

...

Keyword(s):

Foreign Body ◽

Sigmoid Colon ◽

Bowel Preparation ◽

Primary Anastomosis ◽

Standard Form ◽

Colorectal Anastomosis ◽

Sigmoid Resection ◽

Defunctioning Ileostomy ◽

Impacted Foreign Body ◽

Flatus Tube

Colorectal Resections are very often required as an essential surgical procedure for various diseases. These resections are usually accompanied with various forms of diversions with or without primary colo-colonic or colorectal anastomosis. Classically, these are usually preceded by a standard form of bowel preparation. Here, a different form of colorectal surgery without preceding bowel preparation, colorectal resection and primary anastomosis were done, without any covering or defunctioning ileostomy or any other form of diversion or exteriorization and envisaged no complication. A psychiatric adult patient presented with self-introduction of a large foreign body (bobbin) through his anus. On laparotomy, FB (bobbin) impacted at the apex of the loop of sigmoid colon. It was so intensely impacted that milking towards the rectum without serious injury was totally impossible. Sigmoid resection and primary colorectal anastomosis without any form of ileostomy or similar type of diversion or exteriorization was performed. Just before anastomosis, faecal matters were removed as far as possible all from remaining both proximal and distal segments. Then digital anal stretching was done and put a transanastomotic flatus tube through anus. The flatus tube was removed on the 7th post operative day. The outcome was smooth and uneventful. KYAMC Journal Vol. 10, No.-4, January 2020, Page 214-218

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AN EXPERIENCE OF SIGMOID COLON VOLVULUS AT EMMERGENCY WARD LRH

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2016.6.2.798-803 ◽

2011 ◽

Vol 6 (2) ◽

pp. 798-803

Author(s):

USMAN ALI ◽

NAIK ZADA ◽

ASADULLAH ◽

MOHAMMAD SIYAR ◽

ABID ALI

Keyword(s):

Sigmoid Colon ◽

Primary Anastomosis ◽

Standard Procedure ◽

Wound Dehiscence ◽

Sigmoid Volvulus ◽

Full Blood Count ◽

Rectal Tube ◽

Abdominal Colic ◽

Colon Volvulus ◽

Age Range

BACKGROUND: Sigmoid volvulus is a serious condition due to rotation of sigmoid colon. Volvulusoften presents with abdominal colic and distention. It can be managed conservatively by colonoscopicdecompression, followed by optimization of patient and finally surgical procedure. The present studywas based on the comparison of resection of sigmoid colon and double barrel colostomy or resection andprimary anastomosisOBJECTIVE: Objective of the study was to compare the results of primary anastomosis and colostomyin patients presenting with sigmoid volvulus.METHODOLOGY: In this study a total of 48 patients with sigmoid volvulus coming to Accident &Emergency Department were included. All the patients were examined and investigated. After diagnosisbased on x-ray erect abdomen all the patients were admitted in Accident and Emergency ward. Afteradmission Full Blood count, urea, sugar, S. Electrolysis and ECG were also performed. Patients werecatheterized and a nasogastric tube passed for gastric decompression. All the patients were givenintravenous fluids antibiotics and prepared for surgery as facilities for colonoscopic sigmoidscopicdecompression were not available and decompressions by rectal tube was unsuccessfulRESULTS: Among the cases with sigmoid volvulus there were 36 males and 12 were females. Majority28 cases were in age range of 61-70 years. Eight patients had gangrene of sigmoid colon, 23 patients hadresection and colostomy while 20 had resection and primary anastomosis. Among the postoperativecomplications, 05 patients had wound infection and 01 wound dehiscence. Two patients died because ofsepsis and cardiopulmonary complications.CONCLUSION: Patients presenting as acute abdomen should have urgent laparotomy as soon aspossible. Decompression by colonoscope is the gold standard procedure for stable patients with sigmoidvolvulus. Sigmoidectomy and primary anastomosis is the procedure of choice as it not only avoidssecond admission and operation, but it also avoids the side effects and care of stoma, which is majorcause of morbidity and mortality.

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Sigmoid Volvulus in 16-year-old Boy with an Associated Anomalous Congenital Band

The American Surgeon ◽

10.1177/000313481307901114 ◽

2013 ◽

Vol 79 (11) ◽

pp. 1140-1141 ◽

Cited By ~ 4

Author(s):

Ann A. Albert ◽

Tracy L. Nolan ◽

Bryan C. Weidner

Keyword(s):

Abdominal Pain ◽

African American Male ◽

Pediatric Patients ◽

Primary Anastomosis ◽

Exploratory Laparotomy ◽

Sigmoid Volvulus ◽

Sudden Onset ◽

Contrast Enema ◽

Pediatric Age Group ◽

History Of

Sigmoid volvulus, a condition generally seen in debilitated elderly patients, is extremely rare in the pediatric age group. Frequent predisposing conditions that accompany pediatric sigmoid volvulus include intestinal malrotation, omphalomesenteric abnormalities, Hirschsprung's disease, imperforate anus and chronic constipation. A 16-year-old previously healthy African American male presented with a 12 hour history of sudden onset abdominal pain and intractable vomiting. CTwas consistent with sigmoid volvulus. A contrast enema did not reduce the volvulus, but it was colonoscopically reduced. Patient condition initially improved after colonoscopy, but he again became distended with abdominal pain, so he was taken to the operating room. On exploratory laparotomy, a band was discovered where the mesenteries of the sigmoid and small bowel adhered and created a narrow fixation point around which the sigmoid twisted. A sigmoidectomy with primary anastomosis was performed. The diagnosis of sigmoid volvulus may be more difficult in children, with barium enema being the most consistently helpful. Seventy percent of cases do not involve an associated congenital problem, suggesting that some pediatric patients may have congenital redundancy of the sigmoid colon and elongation of its mesentery. The congenital band found in our patient was another potential anatomic factor that led to sigmoid volvulus. Pediatric surgeons, accustomed to unusual problems in children, may thus encounter a condition generally found in the debilitated elderly patient.

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