Sigmoid volvulus



Background

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
  • 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

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 13/12/21.