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Review
. 2010 Dec;42(3):142-7.
doi: 10.5152/eajm.2010.39.

Sigmoid volvulus

S Selcuk Atamanalp  1
Affiliations
Review

Sigmoid volvulus

S Selcuk Atamanalp. Eurasian J Med. 2010 Dec.

Abstract
in English, Turkish

In sigmoid volvulus (SV), the sigmoid colon wraps around itself and its mesentery. SV accounts for 2% to 50% of all colonic obstructions and has an interesting geographic dispersion. SV generally affects adults, and it is more common in males. The etiology of SV is multifactorial and controversial; the main symptoms are abdominal pain, distention, and constipation, while the main signs are abdominal distention and tenderness. Routine laboratory findings are not pathognomonic: Plain abdominal X-ray radiographs show a dilated sigmoid colon and multiple small or large intestinal air-fluid levels, and abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy shows a spiral sphincter-like twist of the mucosa. The diagnosis of SV is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definitive or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful non-operative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%.

Sigmoid volvulus (SV), sigmoid kolonun kendisi ve mezenteri etrafında dönmesidir. SV, tüm kolonik tıkanıklıkların %2–50’sini oluşturur ve ilginç bir coğrafi dağılımı vardır. SV genellikle erişkinleri tutar ve erkeklerde daha sık görülür. SV’nin etiyolojisi çok faktörlü ve tartışmalıdır. Başlıca belirtiler karın ağrısı, şişkinlik ve gaz-gaita çıkaramama iken başlıca bulgular karında şişkinlik ve hassasiyettir. Rutin laboratuar bulguları hastalığa özgü değildir. Düz karın radyografileri genişlemiş bir sigmoid kolon ve çok sayıda ince ya da kalın barsak hava-sıvı seviyelerini gösterir. Karın CT veya MRI’ı dönmüş bir mezenteri ortaya koyar. Fleksibl endoskopi sfinkter benzeri spiral mukoza dönmesini gösterir. SV tanısı klinik, radyolojik, endoskopik ve bazen de operatif bulgulara dayanır. Her ne kadar fleksibl endoskopik detorsiyon başlangıç tedavi seçeneği olarak önerilirse de peritoniti, barsak gangreni veya perforasyonu olan veya nonoperatif tedavinin başarısız olduğu hastalarda acil cerrahi gerekir. Acil cerrahi değişik nondefinitif veya definitif işlemi kapsamakla birlikte, rezeksiyon ve primer anastomoz en çok önerilen işlemdir. Başarılı bir nonoperatif detorsiyon sonrası elektif sigmoid rezeksiyon ve anastomoz, iyi riskli hastalarda önerilir. Toplam mortalite %10–50 iken toplam morbidite %6–24’tür.

Keywords: Intestinal obstruction; Sigmoid colon; Volvulus.

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Figures

Figure 1.
Figure 1.
Schematic diagram of SV.
Figure 2.
Figure 2.
Clinical appearance of SV (asymmetrical distention in abdomen).
Figure 3.
Figure 3.
Plain erect abdominal x-ray film in SV (dilated sigmoid colon and air-fluid levels).
Figure 4.
Figure 4.
Axial CT image in SV (whirl pattern in sigmoid mesentery and dilated sigmoid colon segments).
Figure 5.
Figure 5.
Coronal T2-weighted MRI image in SV (whirl pattern in sigmoid mesentery and dilated sigmoid colon segments).
Figure 6.
Figure 6.
Endoscopic appearance in SV (spiral sphincter-like twist of the sigmoid mucosa).
See this image and copyright information in PMC

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