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Sigmoid Volvulus

Definition:
  • A twist of the sigmoid colon around its mesentery, leading to bowel obstruction and potential ischaemia.
Aetiology and Risk Factors:
  • Chronic constipation.
  • Neurological or psychiatric conditions.
  • Elderly or institutionalised population.
  • High-fibre diet (observed in some populations).
Clinical Features:
  • Abrupt onset of severe abdominal pain.
  • Distension, particularly in the lower abdomen.
  • Constipation and absence of flatus.
  • Vomiting (may become faeculent if not promptly treated).
  • Examination will reveal a tympanitic, tender abdomen.
Investigations:
  • Plain abdominal X-ray:
    • β€œCoffee bean” or “omega loop” sign.
    • Distended sigmoid loop pointing to the right upper quadrant.
  • CT Scan:
    • Confirms diagnosis and assesses for bowel ischaemia.
  • Blood tests:
    • May show raised white cells, lactate (if ischaemia present).
X-ray showing sigmoid volvulus
Management:
  • Initial:
    • Resuscitation with IV fluids.
    • Nasogastric tube insertion to decompress the stomach / GI tract.
    • Antibiotics if signs of systemic infection or ischaemia.
  • Definitive:
    • Endoscopic decompression (sigmoidoscopy):
      • First-line for most patients.
      • May be followed by elective sigmoid colectomy to prevent recurrence.
    • Surgery:
      • Required if there’s suspicion of bowel ischaemia, perforation, or failed non-surgical decompression.
      • Sigmoid colectomy is the procedure of choice.
Complications:
  • Bowel ischaemia or gangrene.
  • Perforation leading to peritonitis.
  • Recurrence if definitive surgical management is not undertaken.
Prognosis:
  • Prompt diagnosis and treatment lead to favourable outcomes.
  • Risk of morbidity and mortality increases with delayed intervention, especially if bowel ischaemia occurs.

Image reference: Radiopaedia.org. From the case: 5575

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