Sigmoid colon volvulus

Sigmoid colon volvulus, also known as sigmoid volvulus, is volvulus affecting the sigmoid colon. It is a common cause of bowel obstruction and constipation. It is common in Asia, India and especially South India because of the high fibre diet. It is a very common cause of large bowel obstruction in Peru and Bolivia due to high altitude.

Signs and symptoms

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

In sigmoid, volvulus rotation is always anticlockwise. It requires one and a half rotation to cause vascular obstruction and gangrene which eventually leads to perforation either at the root or at the summit of the sigmoid loop.

Diagnosis

Plain X-ray : coffee bean sign is seen
Contrast enema: bird beak sign
CT scan: shows characteristic whirl pattern
Blood: haematocrit, renal functions, serum electrolytes

Treatment

RT aspiration
IV fluids
Catheterisation
Antibiotics
By flatus tube or sigmoidoscope, 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
If sigmoid colon is gangrenous, then Hartmann's operation or Paul Mikulicz operation is done