Sigmoid volvulus

Aetiology:

• Aetiology unknown but thought to be secondary to constipation and colonic lengthening.

Risk factors:

• Elderly, debilitated, neurological conditions, institutionalised or taking psychiatric medications, laxative abuse, pregnancy, congenital anomalies e.g. Hirschsprung disease and gut malrotation, and parasitic – Chagas disease. M=F.

Presentation

• abdominal pain, distension and constipation.

Investigations:

• X-ray – coffee bean sign, apex pointing to right upper quadrant.
• CT – whirl sign

Management:

• Fluid and electrolyte abnormalities
• Acute
  • Without perforation or peritonitis
    • Rigid or flexible sigmoidoscopy to detort volvulus
  • With perforation, peritonitis, ischaemia or inability to endoscopically reduce volvulus.
    • Emergency resection
      • Segmental resection + primary anastomosis; unless haemodynamically unstable, intraperitoneal contamination.
• Elective
  • Recurrent sigmoid volvulus or volvulus that was endoscopically detorted
  • Fixation procedures should be avoided. High rate of recurrence