Podcast
Questions and Answers
What anatomical part is primarily affected in sigmoid volvulus?
What anatomical part is primarily affected in sigmoid volvulus?
Which of the following is NOT a common symptom of sigmoid volvulus?
Which of the following is NOT a common symptom of sigmoid volvulus?
Which diagnostic method is considered more definitive for assessing sigmoid volvulus?
Which diagnostic method is considered more definitive for assessing sigmoid volvulus?
What initial management technique is prioritized in treating sigmoid volvulus?
What initial management technique is prioritized in treating sigmoid volvulus?
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Which of the following predisposing factors does NOT contribute to sigmoid volvulus?
Which of the following predisposing factors does NOT contribute to sigmoid volvulus?
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What complication can potentially occur if sigmoid volvulus is left untreated?
What complication can potentially occur if sigmoid volvulus is left untreated?
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Which imaging sign is typically associated with sigmoid volvulus on an abdominal X-ray?
Which imaging sign is typically associated with sigmoid volvulus on an abdominal X-ray?
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Which statement about surgical management of sigmoid volvulus is correct?
Which statement about surgical management of sigmoid volvulus is correct?
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What is a significant concern if bowel distension occurs due to sigmoid volvulus?
What is a significant concern if bowel distension occurs due to sigmoid volvulus?
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Which statement best describes the pathophysiology of sigmoid volvulus?
Which statement best describes the pathophysiology of sigmoid volvulus?
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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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Description
Explore the critical aspects of sigmoid volvulus, including its definition, etiology, pathophysiology, and clinical presentation. This summary highlights the importance of understanding the twisting of the sigmoid colon and its implications in intestinal obstruction, particularly in the elderly.
