Sigmoid Volvulus Overview

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Questions and Answers

What anatomical part is primarily affected in sigmoid volvulus?

  • Rectum
  • Sigmoid colon (correct)
  • Ascending colon
  • Cecum

Which of the following is NOT a common symptom of sigmoid volvulus?

  • Nausea and vomiting
  • Severe headache (correct)
  • Constipation
  • Abdominal distension

Which diagnostic method is considered more definitive for assessing sigmoid volvulus?

  • Abdominal X-ray
  • MRI
  • CT scan (correct)
  • Ultrasound

What initial management technique is prioritized in treating sigmoid volvulus?

<p>Establishing a clear airway (A)</p> Signup and view all the answers

Which of the following predisposing factors does NOT contribute to sigmoid volvulus?

<p>Chronic diarrhea (D)</p> Signup and view all the answers

What complication can potentially occur if sigmoid volvulus is left untreated?

<p>Bowel ischemia (D)</p> Signup and view all the answers

Which imaging sign is typically associated with sigmoid volvulus on an abdominal X-ray?

<p>Coffee bean sign (A)</p> Signup and view all the answers

Which statement about surgical management of sigmoid volvulus is correct?

<p>Resection of the sigmoid colon is an option if ischemia is present. (A)</p> Signup and view all the answers

What is a significant concern if bowel distension occurs due to sigmoid volvulus?

<p>Perforation of the colon (D)</p> Signup and view all the answers

Which statement best describes the pathophysiology of sigmoid volvulus?

<p>Twisting leads to blockade and increased distension. (A)</p> Signup and view all the answers

Flashcards

What is sigmoid volvulus?

Sigmoid volvulus is a twisting of the sigmoid colon, a part of the large intestine.

Who is most likely to develop sigmoid volvulus?

Sigmoid volvulus is a common cause of intestinal obstruction, especially in older adults.

What causes sigmoid volvulus?

Factors contributing to sigmoid volvulus include chronic constipation, reduced bowel motility, and a long, looping sigmoid colon.

How does sigmoid volvulus affect the bowel?

When the sigmoid colon twists, it blocks the passage of stool and gas, leading to pressure build-up and distension.

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What happens if sigmoid volvulus is untreated?

If left untreated, the pressure from a sigmoid volvulus can cause the colon to lose blood supply (ischemia) and even die (necrosis).

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What are the common symptoms of sigmoid volvulus?

Common signs of sigmoid volvulus include sudden abdominal pain, nausea, vomiting, distended belly, and difficulty passing stool or gas.

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How is sigmoid volvulus diagnosed?

Doctors use clinical examination, abdominal X-ray (looking for a 'coffee bean' sign), and CT scan to diagnose sigmoid volvulus.

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How is sigmoid volvulus treated?

Treatment for sigmoid volvulus usually involves decompression of the colon using a tube or colonoscope, but surgery might be necessary if it's severe.

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What are the surgical options for sigmoid volvulus?

Sigmoid volvulus surgery might involve removing the affected part, fixing the colon to prevent re-twisting, or reconstructing the bowel

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What are the complications of sigmoid volvulus?

Untreated sigmoid volvulus can lead to serious complications like ischemia and necrosis, requiring colon resection (removal of the damaged part).

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Study Notes

Definition

  • Sigmoid volvulus is a twisting of the sigmoid colon, a part of the large intestine.
  • It's a common cause of intestinal obstruction in the elderly.

Etiology

  • Predisposing factors for sigmoid volvulus include:
    • Chronic constipation
    • Reduced bowel motility
    • Long redundant sigmoid colon
  • The exact mechanism of volvulus is unclear but involves a combination of these factors.

Pathophysiology

  • The twisting of the sigmoid colon can lead to obstruction of the bowel lumen.
  • This blockage prevents the passage of stool and gas.
  • The resultant pressure buildup can cause significant distension in the colon above the obstruction.
  • If left untreated, the impacted stool can lead to bowel ischemia and necrosis.

Clinical Presentation

  • Common symptoms include:
    • Abdominal pain, often sudden and severe.
    • Nausea and vomiting.
    • Abdominal distension.
    • Constipation.
    • Obstipation.
  • The pain may be intermittent.
  • In later stages, signs of systemic toxicity, like fever and shock, may appear.

Diagnosis

  • Clinical examination, often revealing a palpable "olive" shape mass or distended abdomen.
  • Radiographic imaging, like abdominal X-ray, is often used for initial diagnosis.
    • X-ray findings may show a characteristic "coffee bean" or "inverted U" sign.
  • CT scan provides more detailed information about the extent of the volvulus, potential complications and the presence of ischemia.
  • Lab tests may include complete blood count (CBC) to assess for signs of infection or inflammation.

Treatment

  • Immediate treatment is crucial to prevent complications.
  • Initial management involves:
    • Establishing a clear airway via endotracheal intubation.
    • Intravenous (IV) fluids and electrolyte correction.
  • Non-operative intervention, like decompression using a colonoscope or a tube, is attempted in cases that aren't urgent.
  • Surgical intervention is necessary, particularly for cases with signs of strangulation, bowel ischemia, or when non-operative techniques fail.

Surgical Management

  • Procedures involving:
    • Resection of the affected segment may be required in some circumstances.
    • De-torsion and fixation of the sigmoid colon to prevent recurrence or re-volvulus.
    • Reconstruction of the intestinal pathway to ensure proper function.

Complications

  • Ischemia—reduced blood supply—and necrosis—tissue death—can occur, potentially requiring segmental resection.
  • Perforation of the colon, with subsequent peritonitis.
  • Sepsis and multi-organ failure can occur in severe cases.

Prognosis

  • Early diagnosis and intervention are essential for a favorable outcome.
  • The prognosis depends significantly on:
    • The severity of bowel ischemia at the time of presentation.
    • Pre-existing medical conditions.
    • Promptness of treatment.
  • Overall, while sigmoid volvulus can be serious if left untreated, the outcomes are generally good when timely intervention occurs.

Prevention

  • Prevention strategies mainly focus on managing constipation:
    • Dietary modification to include high-fiber foods.
    • Medications to promote bowel regularity.
    • Regular bowel habits.

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