What Is Sigmoid Volvulus?
Sigmoid Volvulus occurs when an individual suffers from fairly prolonged chronic constipation with development of large, elongated, and atonic colon, especially around the sigmoid colon. This condition is also known by the name of Idiopathic Megacolon. Sigmoid Volvulus occurs when a large sigmoid loop full of feces and distended with gas twists on the mesenteric pedicle creating a closed-loop intestinal obstruction. If not treated adequately, it may lead to fecal peritonitis.
What Are The Causes Of Sigmoid Volvulus?
Sigmoid Volvulus is one of the major causes of colonic obstruction in many parts of the world, but in the United States it is a rare entity. It may be quite rare but there may be cases of undiagnosed Sigmoid Volvulus. Sigmoid colon is the most common area of the GI tract that gets affected with Volvulus and is the reason for intestinal obstruction in about 15% of all cases.
What Are Some Risk Factors For Sigmoid Volvulus?
Some of the risk factors for Sigmoid Volvulus are:
- Elderly Population: The risk for developing a Sigmoid Volvulus increases with increasing age. People above the age of 50 are more prone to develop it.
- Chronic Constipation: This is also one of the major causes of Sigmoid Volvulus and people with longstanding constipation may be at risk for developing it
- Megacolon: An individual suffering from an enlarged colon is predisposed to developing Sigmoid Volvulus
- Gender: Males are more at risk for developing this disease.
What Are Some Of The Symptoms Of Sigmoid Volvulus?
- Sigmoid Volvulus more often than not presents with sudden-onset lower abdominal pain along with abdominal distension with inability to pass gas or have a bowel movement.
- There may also be insidious onset of chronic abdominal distension, constipation, and colicky pain in stomach along with severe vomiting episodes.
- The affected individual may have periods where he may experience recurrent attacks of constipation followed by passing of large amounts of stool or gas.
- If the distension becomes quite severe then the individual may experience vomiting episodes
- If an abdominal examination is conducted then it will reveal a distended abdomen. There may also be a palpable mass observed.
- In cases of colonic perforation due to Sigmoid Volvulus then high fever may also be observed.
- Any delay in treatment for Sigmoid Volvulus may lead to development of colonic ischemia or peritonitis.
How Is Sigmoid Volvulus Diagnosed?
In order to diagnose Sigmoid Volvulus the following studies will be done:
- Abdominal X-rays: The abdominal x-ray will reveal a dilated sigmoid loop.
- Barium Enema: This test is also helpful in confirming the diagnosis of Sigmoid Volvulus.
- Imaging: CT scan of the abdomen to look at the internal structures of the abdomen virtually confirms the diagnosis of Sigmoid Volvulus.
What Are The Treatments For Sigmoid Volvulus?
The frontline treatment for Sigmoid Volvulus is an emergent surgery to untwist the sigmoid. Many cases of Sigmoid Volvulus have been treated successfully with noninvasive decompression techniques but again surgery is the recommended treatment due to a high recurrence rate in noninvasive procedures.
Decompression To Correct Sigmoid Volvulus: In this procedure, the patient is placed in a left lateral position and a sigmoidoscope is passed through the rectum and then passed gently through the twisted bowel and gently untwisting the bowel. This results in a huge flow of liquid feces and thus the obstruction is corrected. This procedure facilitates quick decompression of distended colon bringing in immediate relief from symptoms. The tube is left for 24 hours to maintain decompression and prevent recurrence.
Surgery For Sigmoid Volvulus: The best way of treatment surgically for Sigmoid Volvulus is the resection of the sigmoid colon. Surgery is indicated for those individual in which the decompression procedure has failed and there are signs indicative of bowel ischemia.
Even after a successful conservative treatment, the chances of the Sigmoid Volvulus recurring is about 60%. If the condition recurs after noninvasive treatment then surgery is performed in order to prevent recurrence.
What Are The Complications Of Sigmoid Volvulus?
Some of the complications of Sigmoid Volvulus are:
- Chances of recurrence
- Bowel obstruction
- Perforation along with fecal peritonitis.
Diet Plan For Treatment Of Volvulus
There are certain dietary modifications which can be done pre and post treatment for individual affected with Sigmoid Volvulus. Some of the dietary modifications are as mentioned below:
- The affected individual will need to eat more small meals instead of one large meal in a day so that the digestive system is not under pressure to digest large amounts of food at one time and also provide the body with adequate nutrition
- In cases of Sigmoid Volvulus, especially postsurgery, it is recommended that the individual if possible stay away from foods rich in fiber like apples, nuts, broccoli, and instead try and consume a bland diet. It is also recommended to stay away from spicy or fried foods as it is difficult to digest and it may also slow down the healing process
- Avoiding constipation is also necessary in Volvulus and constipation may occur, especially if there is reduced fiber intake. Thus, it is recommended that the individual consume plenty of water to avoid constipation.
In case if an individual is diagnosed with Volvulus, once it is recommended to take care of the diet as Volvulus even after being treated has a tendency to recur. Since some of the intestine is removed during surgery for Volvulus the body finds it difficult to absorb vital minerals and vitamins; therefore, it becomes necessary for the individual to be on electrolyte replacement so that the body does not get devoid of any vital electrolytes or minerals.
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