Sigmoid Volvulus Review

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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?

Ensures timely recognition and prompt decompression Signup and view all the answers

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

Narrow sigmoid mesentery base Signup and view all the answers

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

Continued distension leads to perforation Signup and view all the answers

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

Worsening abdominal distension Signup and view all the answers

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

Africa Signup and view all the answers

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

Mucosa Signup and view all the answers

What is the classic radiographic sign of sigmoid volvulus?

Coffee bean sign Signup and view all the answers

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

Loss of appetite Signup and view all the answers

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

Bedside decompression with a flatus tube Signup and view all the answers

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

Bowel perforation Signup and view all the answers

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

Discussing risks and benefits of elective resection Signup and view all the answers

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

CT scan Signup and view all the answers

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

Chronic constipation Signup and view all the answers

What is a possible consequence of poorly managed sigmoid volvulus?

Peritonitis Signup and view all the answers

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

Sigmoid colectomy Signup and view all the answers

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

Rebound tenderness Signup and view all the answers

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

Executing decompression against resistance Signup and view all the answers

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

To avoid recurrence of volvulus Signup and view all the answers

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.

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Description

This quiz provides an in-depth review of sigmoid volvulus, exploring its definition, prevalence, risk factors, and pathophysiology. Understand the implications of closed-loop obstructions and the associated complications like ischemia and bacterial translocation. Dive into the crucial aspects of this condition to enhance your knowledge in gastrointestinal health.