Sigmoid Volvulus Review

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson
Download our mobile app to listen on the go
Get App

Questions and Answers

What is the most common type of colonic volvulus?

  • Ileal volvulus
  • Caecal volvulus
  • Sigmoid volvulus (correct)
  • Transverse colon volvulus

Which patient demographic is most likely to present with sigmoid volvulus?

  • Active athletes with dietary issues
  • Patients with recent abdominal surgery
  • Young adults with active lifestyles
  • Bedbound elderly individuals with chronic constipation (correct)

What is a key indicator for suspected sigmoid volvulus?

  • Diminished or absent bowel output (correct)
  • Increased appetite
  • Frequent diarrhea
  • Persistent nausea without abdominal pain

What role does the interprofessional team play in managing sigmoid volvulus?

<p>Ensures timely recognition and prompt decompression (B)</p> Signup and view all the answers

Which anatomical feature contributes to the occurrence of sigmoid volvulus in certain populations?

<p>Narrow sigmoid mesentery base (D)</p> Signup and view all the answers

What happens when both inflow and outflow of the colon are obstructed in sigmoid volvulus?

<p>Continued distension leads to perforation (B)</p> Signup and view all the answers

Which of the following is a common symptom of sigmoid volvulus?

<p>Worsening abdominal distension (C)</p> Signup and view all the answers

In which region is sigmoid volvulus more prevalent due to dietary habits and anatomical factors?

<p>Africa (B)</p> Signup and view all the answers

What is the most susceptible area of the colon to ischaemic insult during a volvulus?

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

What is the classic radiographic sign of sigmoid volvulus?

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

Which of the following symptoms is most commonly associated with acute hospital admission for sigmoid volvulus?

<p>Loss of appetite (B)</p> Signup and view all the answers

What is the initial non-surgical intervention for a patient with sigmoid volvulus?

<p>Bedside decompression with a flatus tube (A)</p> Signup and view all the answers

What condition can be indicated by free air on an abdominal radiograph in a patient with suspected volvulus?

<p>Bowel perforation (B)</p> Signup and view all the answers

For a patient with recurrent episodes of sigmoid volvulus, what is a key consideration before surgery?

<p>Discussing risks and benefits of elective resection (D)</p> Signup and view all the answers

Which test is recommended to distinguish volvulus from other causes of large bowel obstruction?

<p>CT scan (D)</p> Signup and view all the answers

Which of the following conditions may contribute to the development of sigmoid volvulus?

<p>Chronic constipation (A)</p> Signup and view all the answers

What is a possible consequence of poorly managed sigmoid volvulus?

<p>Peritonitis (A)</p> Signup and view all the answers

What is the primary surgical procedure performed for patients with compromised bowel viability due to volvulus?

<p>Sigmoid colectomy (C)</p> Signup and view all the answers

Which physical examination finding could indicate the presence of ischemia or impending perforation in a volvulus patient?

<p>Rebound tenderness (C)</p> Signup and view all the answers

What is an important precaution during bedside decompression of a sigmoid volvulus?

<p>Executing decompression against resistance (D)</p> Signup and view all the answers

Why is it essential to reassess a patient for sustained resolution after decompression?

<p>To avoid recurrence of volvulus (A)</p> Signup and view all the answers

Flashcards

What is a volvulus?

A twist in the intestine around its blood supply, most commonly occurring in the sigmoid colon at the base of the mesentery.

Who is more likely to experience sigmoid volvulus?

Sigmoid volvulus is the most common type of colonic volvulus, often seen in those with chronic constipation and limited mobility.

What causes a sigmoid volvulus?

A narrowed base of the sigmoid mesentery allows the sigmoid colon to twist, creating a volvulus.

Where is sigmoid volvulus more common?

Sigmoid volvulus occurs more frequently in Africa due to a combination of high-fiber diets and a narrower sigmoid mesentery base in the African population.

Signup and view all the flashcards

What is a large bowel closed loop obstruction?

A large bowel obstruction where both inflow and outflow are blocked, allowing gas to accumulate and increase pressure.

Signup and view all the flashcards

What can happen if a large bowel closed loop obstruction is untreated?

The trapped gas in a closed loop obstruction causes distention, which can eventually lead to a perforation or rupture of the obstructed bowel.

Signup and view all the flashcards

What are the typical symptoms of sigmoid volvulus?

Loss of appetite, reduced or absent bowel movements, and worsening abdominal distension.

Signup and view all the flashcards

How are sigmoid volvulus diagnosed and treated?

Sigmoid volvulus can be diagnosed with imaging studies like X-rays or CT scans. Treatment typically involves decompression of the colon and possible surgery for severe cases.

Signup and view all the flashcards

Sigmoid Volvulus

A twisting of the sigmoid colon, causing obstruction and potentially leading to reduced blood flow and tissue damage.

Signup and view all the flashcards

Ischemia

Reduced blood flow to an organ or tissue, often due to obstruction.

Signup and view all the flashcards

Bacterial Translocation

The movement of bacteria from the intestines into the bloodstream, usually due to a compromised gut barrier.

Signup and view all the flashcards

Compromised Venous Outflow

A decreased ability for blood to leave an area, often resulting in swelling and congestion.

Signup and view all the flashcards

Colonic Serosa

The outermost layer of the colon, which can be affected by ischemia and lead to complications like perforation.

Signup and view all the flashcards

Colonic Perforation

A complete tear or hole in the wall of the colon, often a consequence of severe ischemia.

Signup and view all the flashcards

Mesenteric Fibrosis

The formation of scar tissue, often occurring in the mesentery following repeated episodes of sigmoid volvulus.

Signup and view all the flashcards

CT Scan

A medical imaging technique that provides detailed images of internal organs and structures.

Signup and view all the flashcards

Sigmoidoscopy

A visual examination of the inside of the colon using a flexible tube with a camera.

Signup and view all the flashcards

Sigmoid Colectomy

A procedure to remove a portion of the sigmoid colon, often used to treat recurrent sigmoid volvulus.

Signup and view all the flashcards

Colostomy

A temporary opening created in the colon to allow for drainage, often used after a colectomy.

Signup and view all the flashcards

Appendicitis

A condition characterized by inflammation and pain in the appendix.

Signup and view all the flashcards

Bowel Obstruction

A blockage in the intestines, preventing the passage of food and feces.

Signup and view all the flashcards

Diabetic Ketoacidosis

A condition characterized by low blood sugar levels, often associated with diabetes.

Signup and view all the flashcards

Gastroparesis

A condition where the stomach empties slowly, often leading to nausea and vomiting.

Signup and view all the flashcards

Study Notes

Sigmoid Volvulus: A Review

  • Definition: Sigmoid volvulus is a twisting of the sigmoid colon around its mesentery, obstructing blood flow.
  • Prevalence: The most common type of colonic volvulus.

Risk Factors

  • Immobility: Common in bedridden or institutionalized patients.
  • Chronic constipation: Leads to distended and redundant colon, increasing risk.
  • Ethnic factors (Epidemiology): More common in African populations due to narrower sigmoid mesentery.

Pathophysiology

  • Closed-loop obstruction: Inflow and outflow of the colon are blocked, leading to distension and gas buildup.
  • Ischemia: Twisted bowel reduces blood supply, causing ischemia (tissue damage due to lack of blood).
  • Bacterial translocation: Compromised blood supply lets bacteria escape gut lining, leading to infection.
  • Necrosis and perforation: Progressive ischemia can cause tissue death and bowel rupture.
  • Recurrence: Sigmoid volvulus can recur, usually after conservative treatment, due to fibrosis and chronic distension.

Clinical Presentation

  • Age: Typically older patients with comorbidities.
  • Symptoms: Loss of appetite, reduced bowel movements, increasing abdominal distension, discomfort (not necessarily pain), potentially respiratory compromise.
  • Physical exam: Significant abdominal distension, tympany, potential guarding/rebound if ischemia or perforation is present. Empty rectum.
  • Recurrent episodes: Treat similar to initial presentation.

Diagnosis

  • Blood work: Full blood count and renal function tests (for resuscitation and assessing kidney function for CT scan).
  • Radiography: Plain abdominal X-rays may show the "coffee bean" or "kidney bean" sign, and proximal colon dilatation.
  • CT scan (with/without contrast): Key diagnostic tool; shows twisted mesentery, distended sigmoid colon, air-fluid levels. Essential to differentiate from other causes of obstruction, including tumors.

Treatment

  • Initial treatment: Intravenous fluids to rehydrate, electrolyte correction, Nasogastric tube for proximal decompression.

  • Decompression (bedside): Soft rectal flatus tube, ideally under direct sigmoidoscopic guidance; for failed attempts flexible sigmoidoscopy is used for direct inspection.

  • Surgical intervention: Sigmoid colectomy (removal of the sigmoid colon), either with anastomosis (reconnecting the colon) or end colostomy (creating an opening in the abdominal wall). Emergency laparotomy for perforation cases.

  • Recurrent cases: Options include elective sigmoid colectomy to prevent further episodes.

Differential Diagnosis

  • A list of other conditions that may mimic the symptoms of sigmoid volvulus.

Important Considerations

  • Iatrogenic perforation: Only experienced physicians should perform bedside decompression to avoid unnecessary perforation.
  • Direct visualization: Rigid or flexible sigmoidoscopy is the safest method to decompress sigmoid.
  • Monitoring: Check for sustained resolution after decompression & oral intake and prevent recurrence before discharging.
  • Interprofessional team: Collaboration among surgeons, gastroenterologists, primary care providers, nurses, and internists is vital in prompt diagnosis and management. Careful consideration of concurrent comorbidities is key.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

More Like This

Use Quizgecko on...
Browser
Open
Browser
Browser