• imaging in sigmoid volvulus
• mesentero-axial sigmoid volvulus
• organo-axial sigmoid volvulus
• sigmoid volvulus follow-up

• Anticoagulation
• Bleeding
• Colonoscopy
• Critical care
• Endoscopy
• Intensive care

• cecal volvulus
• colonic volvulus
• sigmoid volvulus
• volvulus

• Early recurrence
• Endoscopic detorsion
• Sigmoid volvulus

• Case report
• Cecum volvulus
• Colon volvulus
• Double colon volvulus
• Sigmoid volvulus

• Humans
• Intestinal Volvulus/surgery
• Intestinal Volvulus/diagnostic imaging
• Intestinal Volvulus/complications
• Male
• Middle Aged
• Colon, Sigmoid/diagnostic imaging
• Colon, Sigmoid/surgery
• Colon, Sigmoid/pathology
• Cecal Diseases/surgery
• Cecal Diseases/diagnostic imaging
• Sigmoid Diseases/diagnostic imaging
• Sigmoid Diseases/surgery
• Intestinal Obstruction/surgery
• Intestinal Obstruction/etiology
• Intestinal Obstruction/diagnostic imaging
• Cecum/diagnostic imaging
• Cecum/pathology
• Laparotomy
• Treatment Outcome

• Sigmoid colectomy
• Sigmoid volvulus

• Humans
• Intestinal Volvulus/surgery
• Aged
• Female
• Male
• Colectomy/methods
• Colectomy/economics
• Sigmoid Diseases/surgery
• Aged, 80 and over
• Decompression, Surgical/economics
• Decompression, Surgical/methods
• Length of Stay/statistics & numerical data
• Retrospective Studies
• Treatment Outcome
• Postoperative Complications/epidemiology
• Time-to-Treatment/statistics & numerical data
• Time Factors

• mesenteric volvulus
• malrotation
• midgut volvulus
• whirlpool sign
• acute abdominal pain

• abdominal volvulus
• complications
• diagnostic evaluation
• gastrointestinal obstruction
• multidisciplinary approach
• surgical management

• appendicitis
• colonic perforation
• sigmoid volvulus

• Humans
• Aged
• Intestinal Volvulus/surgery
• Intestinal Volvulus/complications
• Decompression, Surgical
• Lumbar Vertebrae/surgery
• Colonic Diseases/surgery

• anterior compartment syndrome
• gangrene
• intraabdominal pressure
• ischemia
• perforation
• peritonitins
• prognosis
• sepsis
• shoch
• sigmoid volvulus

• Anastomotic leak
• Risk factors
• Sigmoid volvulus
• Sigmoidectomy

Acute sigmoid volvulus (ASV) represents a small but significant portion of cases of large bowel obstruction, especially in the elderly and co-morbid. Given the characteristics of the patient cohort most commonly affected, a non-operative/conservative approach is often undertaken but is associated with a high rate of recurrence.

We sought to evaluate outcomes for those patients who underwent non-operative management, emergency surgery or staged, semi-elective surgery following decompression for ASV at our institution.

Hospital in-patient enquiry (HIPE) data were used to identify all patients who presented with sigmoid volvulus between January 2005 and June 2020 inclusive. Patient notes were interrogated, including surgical and endoscopic procedures performed. Patient demographics and co-morbidities were recorded.

Thirty-nine patients were treated over a 15-year period with a mean age of 73 years at first presentation (range 36–93). Twenty-two patients (56%) had just a single admission for ASV with three deaths in this group.

Seventeen patients (44%) had more than one admission with volvulus due to recurrence after a decompression-only strategy on the index admission. Of these, three succumbed to complications of their subsequent episodes of volvulus.

Twenty-five patients underwent surgical intervention (fifteen on, or shortly following, their first admission and ten following at least two admissions for ASV). The overall mortality in the operative group was 2/25 (8%) with both deaths in those undergoing emergency surgeries. Five patients were treated successfully with endoscopic measures alone and had required no further interventions at the time of compiling data.

There is a high recurrence rate following non-operative management of acute sigmoid volvulus and consequently, a cumulative increase in the attendant significant morbidity and mortality with subsequent episodes. Given the relatively low complication rate of definitive surgery, even in those patients perceived to be high risk, we contend that all patients should be considered for early surgery to prevent the likely recurrence of sigmoid volvulus.

• Endoscopic decompression
• Preventative surgery
• Recurrent volvulus
• Sigmoid volvulus
• Surgery

• Endoscopy
• Gangrene
• Intestinal obstruction
• Perforation
• Sigmoid volvulus

• Infarction
• Intestinal obstruction
• Sigmoid volvulus
• Wandering spleen

• colorectal surgery
• emergency
• guideliness

• Colorectal Surgery
• Consensus
• Digestive System Surgical Procedures
• Emergency Service, Hospital
• Humans
• United Kingdom

A sigmoid volvulus occurs when a segment of the colon twists upon its mesentery. This infliction is associated with old age, multiple co-morbidities, and the male sex. We present a rare case of sigmoid volvulus that occurred in a healthy young female.

A 28-year-old female presented with a one week history of constipation and abdominal pain. Her symptoms suddenly worsened and became associated with vomiting and severe pain. A focused history taking and physical examination showed peritoneal signs that led to timely diagnostic imaging to be implemented. Computed tomography (CT) of the abdomen was consistent with sigmoid volvulus. Our patient underwent emergent laparotomy with a sigmoidectomy and recovered with no post-operative complications.

This case report emphasizes the importance of clinicians maintaining a sigmoid volvulus as a rare, yet important differential when approaching abdominal pain in young healthy patients.

• Bowel obstruction
• Emergent surgery
• Sigmoid colon
• Sigmoidectomy
• Volvulus

• Adult
• Aged, 80 and over
• Child
• Child, Preschool
• Female
• Hirschsprung Disease/complications
• Hirschsprung Disease/diagnosis
• Hirschsprung Disease/epidemiology
• Humans
• Infant
• Infant, Newborn
• Intestinal Volvulus/diagnosis
• Intestinal Volvulus/epidemiology
• Intestinal Volvulus/etiology
• Male

• Laparotomy
• Mini-incision
• Sigmoidectomy
• Volvulus

• abdominal obstruction
• sigmoid colon
• sigmoid volvulus

Colonic volvulus constitutes a significant cause of large bowel obstruction in adults. Most studies of colonic volvulus come from high endemic zones and are limited by the small number of patients. In our region, there is a shortage of studies concerning this disorder, and treatment of colonic volvulus remains controversial.

This is a retrospective study of 34 patients who presented with colonic volvulus at a single academic institution in a 4-year period and their respective treatment and outcomes.

A total of 34 patients, 17 males (50%) and 17 females (50%), with a mean age of 55 ± 23.9 years underwent treatment for colonic volvulus. Twelve patients (35.3%) underwent initial decompression, followed by a Hartman procedure in 4 patients (11.7%) and sigmoid resection with primary anastomosis in 3 patients (8.8%), with 3 fatalities (8.8%) following initial decompression. Two patients (5.8%) were lost to follow-up. Twenty-two patients (64.7%) underwent emergency surgery, of whom 16 (47%) underwent a Hartman procedure, with colorectal anastomosis in 9 patients (26.4%), with 3 fatalities (8.8%) immediately after the first procedure. Four patients (11.7%) were lost to follow up after the Hartman procedure. Of the 6 remaining patients (17.6%), of the emergency surgical group, 3 patients (8.8%) had an initial sigmoidectomy and primary anastomosis, and the remaining 3 patients (8.8%) had a cecal volvulus with a right hemicolectomy performed with primary anastomosis in 2 patients (5.8%) and with a fatality in the remaining patient, on whom a terminal ileostomy was performed for damage control. The mean hospital stay was 5.7 days, with an overall mortality rate of 23.5%.

Acute colonic volvulus in our region is not as uncommon as in other parts of the world. This disorder must be suspected when a patient presents with abdominal pain, abdominal distension, and bean sign on plain X-rays and/or a whirl sign on computed tomography scan.

• Cecal volvulus
• Colonic volvulus
• Decompression
• Large bowel obstruction
• Sigmoid volvulus

• Acute Disease
• Cecum/surgery
• Cholinesterase Inhibitors/therapeutic use
• Colonic Pseudo-Obstruction/therapy
• Colonoscopy/methods
• Colostomy/methods
• Conservative Treatment
• Decompression, Surgical/methods
• Endoscopy, Gastrointestinal/methods
• Humans
• Intestinal Volvulus/therapy
• Neostigmine/therapeutic use
• Sigmoid Diseases/therapy
• Societies, Medical
• United States

There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them.

• Balloon dilatation
• Enteral stent
• Intestinal obstruction

• Colonic surgery
• Endoscopic treatment
• Geriatrics
• Sigmoid volvulus

• Adult
• Aged
• Aged, 80 and over
• Colectomy/methods
• Colonoscopy
• Elective Surgical Procedures/methods
• Female
• France
• Humans
• Intestinal Volvulus/mortality
• Intestinal Volvulus/surgery
• Male
• Middle Aged
• Recurrence
• Retrospective Studies
• Sigmoid Diseases/mortality
• Sigmoid Diseases/surgery
• Tomography, X-Ray Computed

• Ischemia
• laparotomy
• obstipation
• roentgenogram
• sigmoid volvulus
• strangulation
• torsion

• Acute sigmoid volvulus
• Colonoscopy
• Sigmoid colon

• Endoscopy
• Ischemia
• Sigmoid Colon
• Treatment
• Volvulus

• Diagnosis
• Sigmoid colon
• Sigmoidoscopy
• Treatment
• Volvulus

•

Dual closed loop obstruction: one due to the sigmoid volvulus and the other due to a competent ileocaecal valve.

Closed loop obstruction is commonly encountered in sigmoid volvulus. When such obstruction becomes fulminant, it is called acute necrotizing colitis. Gangrene of the entire large bowel from the caecum till the distal end of the sigmoid is a rare entity.

We present here one such case of necrotizing colitis in a 27 years old gentleman who presented with large bowel obstruction and septic shock. Computed tomography (CT) revealed sigmoid volvulus with ischaemic changes. The rest of the colon was dilated. On laparotomy, a gangrenous sigmoid due to the volvulus was found along with complete gangrene of the proximal bowel from the ileocaecal junction till the volvulus. This was probably due to a double closed loop obstruction, one at the sigmoid volvulus and the second being between a probable competent ileocaecal valve and the proximal end of the volvulus. A total colectomy with an end ileostomy was performed.

Necrotising colitis involving the entire colon is seldom seen. Large bowel obstruction is a known surgical emergency due to a probable closed loop obstruction due to a competent ileocaecal valve.

To our knowledge, such gangrene of the entire large bowel due to a sigmoid volvulus and a competent ileocaecal valve has not been reported in literature so far. We also highlight here, the rapid ischaemic changes that follow a closed loop obstruction. In our case the CT has shown ischaemic changes only in the sigmoid. Hence, timely diagnosis and intervention is imperative.

• Closed loop obstruction
• Large bowel gangrene
• Sigmoid volvulus
• Total colectomy

• Adult
• Colonic Diseases/etiology
• Colonoscopy/adverse effects
• Decompression, Surgical/adverse effects
• Humans
• Intestinal Volvulus/surgery
• Intussusception/etiology
• Male
• Recurrence

Sigmoid volvulus is a common cause of intestinal obstruction in developing countries where it affects relatively young people compared to developed countries. No prospective study has been done on this subject in Tanzania and Bugando Medical Centre in particular. This study describes in our region, the clinical presentation, management and outcome of sigmoid volvulus.

This was a descriptive prospective study of patients operated for sigmoid volvulus at Bugando Medical Centre from March 2009 to February 2014.

A total of 146 patients (M: F = 5.1: 1) representing 14.2% of all cases of bowel obstruction were studied. The median age at presentation was 48 years. The disease significantly affected the older males compared with females (P = 0.012). The majority of the patients 102, (93.2%) presented acutely and had to undergo emergency surgical intervention, the rest were either sub-acute or chronic. Out of the 146 patients studied, 24 (16.4%) had ileo-sigmoid knotting. The majority of patients, 102(69.9%) were treated with resection and primary anastomosis, of which 63.0% were emergency cases. Colostomy was offered to 30.1% of cases. No patient had sigmoidoscopic derotation. Complications mainly surgical site infections were reported in 20.5% of cases. The overall median length of hospital stay was 14 days. Overall mortality rate was 17.1%. The main predictors of mortality were advanced age (>60 years), concomitant medical illness, late presentation (≥24 hours), presence of shock on admission and presence of gangrenous bowel (P < 0.001). The follow up of patients in this study was generally poor as more than half of patients were lost to follow up.

Sigmoid volvulus is not uncommon in our setting and commonly affects males than females. Most of the patients presented acutely, requiring immediate resuscitation and surgical approach. Findings from this study suggest that in viable bowel, sigmoid resection and primary anastomosis is feasible as it may not adversely affect outcome. Temporary colostomy should be considered if the bowel is gangrenous or perforated. Early diagnosis and timely definitive treatment are essential in order to decrease the morbidity and mortality associated with this disease.

• Clinical presentation
• Management
• Outcome
• Sigmoid volvulus
• Tanzania

• Adult
• Aged
• Aged, 80 and over
• Decompression, Surgical
• Female
• Follow-Up Studies
• Humans
• Ilium/surgery
• Intestinal Volvulus/surgery
• Laparotomy/methods
• Male
• Middle Aged
• Recurrence
• Sigmoid Diseases/surgery
• Treatment Outcome

• Delayed perforation
• emergency operation
• endoscopic reduction
• septic shock
• sigmoid volvulus