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, distention, 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 apposing 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
