Sigmoid colon volvulus, also known as sigmoid volvulus, is volvulus affecting the

sigmoid colon The sigmoid colon (or pelvic colon) is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about in length. The loop is typically shaped like a Greek letter sigma (ς) or Latin letter S (thus ''s ...

. It is a common cause of

bowel obstruction Bowel obstruction, also known as intestinal obstruction, is a mechanical or Ileus, functional obstruction of the Gastrointestinal tract#Lower gastrointestinal tract, intestines which prevents the normal movement of the products of digestion. Eith ...

and constipation. It is common in Asia, India (7% of intestinal obstruction) and especially South India because of the high

fibre Fiber or fibre (from la, fibra, links=no) is a natural or artificial substance that is significantly longer than it is wide. Fibers are often used in the manufacture of other materials. The strongest engineering materials often incorporate ...

diet. It is a very common cause of large bowel obstruction in Peru and

Bolivia , image_flag = Bandera de Bolivia (Estado).svg , flag_alt = Horizontal tricolor (red, yellow, and green from top to bottom) with the coat of arms of Bolivia in the center , flag_alt2 = 7 × 7 square p ...

due to high altitude.

Signs and symptoms

* Pain in abdomen – initially left-sided, eventually all over * Absolute constipation * Enormous

distension Distension (spelled distention in many style regimens) generally refers to an enlargement, dilation, or ballooning effect. It may refer to: * Abdominal distension, typically a symptom of an underlying disease or dysfunction in the body, rather th ...

of abdomen * Late vomiting and eventually dehydration * Features of peritonitis * Hiccup and retching may occur * Tyre-like feel of the abdomen is diagnostic

Cause

The condition is more common in males and with old age. It is also common in people with chronic constipation and laxative abuse. It is common in: * Ogilvie syndrome * Individuals with learning difficulties *

Chagas disease Chagas disease, also known as American trypanosomiasis, is a tropical parasitic disease caused by ''Trypanosoma cruzi''. It is spread mostly by insects in the subfamily ''Triatominae'', known as "kissing bugs". The symptoms change over the cou ...

Hypothyroidism Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland does not produce enough thyroid hormone. It can cause a number of symptoms, such as po ...

* Anticholinergic drugs *

Multiple sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This d ...

* Scleroderma * Parkinson's disease In sigmoid, volvulus rotation is always anticlockwise. It requires one and a half rotation to cause

vascular obstruction Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems wit ...

and

gangrene Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the ga ...

which eventually leads to perforation either at the root or at the summit of the sigmoid loop.

Diagnosis

# Plain X-ray (diagnostic in 70–80%): coffee bean sign is seen # Contrast enema: bird beak sign # CT scan: shows characteristic whirl pattern # Blood:

haematocrit The hematocrit () (Ht or HCT), also known by several other names, is the volume percentage (vol%) of red blood cells (RBCs) in blood, measured as part of a blood test. The measurement depends on the number and size of red blood cells. It is no ...

, renal functions, serum electrolytes

Treatment

* RT aspiration * IV fluids * Catheterisation * Antibiotics * By

flatus tube Flatulence, in humans, is the expulsion of gas from the intestines via the anus, commonly referred to as farting. "Flatus" is the medical word for gas generated in the stomach or bowels. A proportion of intestinal gas may be swallowed environm ...

sigmoidoscope Sigmoidoscopy (from the Greek term for letter " s/ς" + "eidos" + "scopy": namely, to look inside an "s"/"ς"-like object) is the minimally invasive medical examination of the large intestine from the rectum through to the nearest part of the col ...

, derotation is done * If derotation does not occur, then laparotomy through midline incision should be done. It is derotated manually. If viable, it can be fixed to lateral wall of abdomen or

pelvis The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The ...

* If sigmoid colon is gangrenous, then

Hartmann's operation A proctosigmoidectomy, Hartmann's operation or Hartmann's procedure is the surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy. It was used to treat colon cancer or inflammation (proct ...

Paul Mikulicz Paul may refer to: *Paul (given name), a given name (includes a list of people with that name) *Paul (surname), a list of people People Christianity *Paul the Apostle (AD c.5–c.64/65), also known as Saul of Tarsus or Saint Paul, early Chris ...

operation is done

References

External links

{{Medical resources , DiseasesDB = , ICD10 = {{ICD10, Xxx.x , ICD9 = {{ICD9, xxx , OMIM = , MedlinePlus = , MeSH = , ICDO = , Orphanet = Human diseases and disorders Diseases of intestines