Sigmoid Volvulus

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📺 Teaching Video:
https://youtu.be/Z-SdOaWs16o&list=PLOlpsJ0eDlASRw1LywI2iGfzDTqxlAYFJ

Sigmoid Volvulus
- Sigmoid volvulus = twisting of sigmoid colon around its mesentery
- Causes a closed-loop bowel obstruction, impairing blood flow
- Risk of ischemia and perforation if untreated
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Risk Factors for Sigmoid Volvulus
- Chronic constipation increases colonic redundancy
- High-fiber diets lead to bulky stool and colon distension
- Institutionalization (e.g., nursing homes) due to immobility and chronic constipation
- Congenital conditions like Hirschsprung’s disease predispose to volvulus
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Clinical Presentation
- Progressive abdominal distension and pain
- Nausea, vomiting, and constipation or obstipation
- Symptoms may develop gradually, especially in elderly patients
- Cognitive impairment may delay symptom recognition
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Diagnostic Imaging
- Abdominal X-ray: "Coffee bean sign" — massively dilated sigmoid loop
- CT scan: "Whirl sign" — twisted mesentery visible
- Imaging is critical for early diagnosis and management planning
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Management Approach
- Initial step: Endoscopic decompression in stable patients
- High recurrence rate after non-surgical decompression
- Definitive treatment: Surgical resection (e.g., sigmoid colectomy)
- Emergency surgery required if signs of peritonitis or decompression failure
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Prognosis and Key Points
- Mortality increases significantly with bowel ischemia or perforation
- Early diagnosis and timely intervention are critical to survival
- Recurrence risk necessitates planning for definitive surgical management

📺 Teaching Video:
https://youtu.be/Z-SdOaWs16o&list=PLOlpsJ0eDlASRw1LywI2iGfzDTqxlAYFJ