Sigmoid volvulus

• Rotation (clockwise = anticlockwise) of section of intestine on its mesentry.
• Eventually leads obstruction (5% of all large bowel obstructions) and bowel ischaemia
• >50% patients >70 years old (many have co-morbidities including psychiatric and chronic constipation)
• High incidence in pregnancy (25% of all obstructions) - perhaps triggered by displacement of the colon

Clinical

• Presents with obstruction (absolute) or partial (recurrent symptoms)
  • Pain, distension, constipation
• Local (bowel ischaemia) or generalised (perforation) peritonism
• SIRS (systemic inflam. response synd.) and constitutional collapse
  • Hi AG acidosis, lactic acidosis
• Plain x-ray often diagnostic
  • Dilated loop to T12
  • Loss haustrae
  • "Coffee bean" sign (vertical live of opposing loop walls)
  • No rectal gas

Management

• Analgesia
• Active resuscitation if toxic
• Surgery of local or generalised peritonism
• Decompression (under endoscopic or radiological guidance)
  • Early (day 0) discharge if successful but beware recurrence