Review of Sigmoid Volvulus: A 5 Years Experience in Tertiary Care Hospital, Visakhapatnam

Abstract

BACKGROUNDSigmoid volvulus is a common cause of large bowel obstruction in developing countries where it affects relatively young people compared to developed countries and its mortality remains significant in patients with late diagnosis. The aim of this work is to assess the clinical presentation, management and outcome of sigmoid volvulus.

Sigmoid Volvulus Due Chagas Disease

“…The first description with reference to the volvulus was found in the records of Egypt in the Ebers papyrus and mentioned that the volvulus could resolve spontaneously or present a picture of intestinal necrosis; from 1500 BC, it is recognized that detortion of the intestinal loop is crucial for the definitive resolution of the picture, and there are also records made by Hippocrates where suppositories and insufflation were used by mechanical instruments introduced in the anus in order to generate decompression [6]. However, the first description coined with the term Sigmoid volvulus was made by Von Rokitansky in 1836, demonstrating a condition in which the sigmoid wraps itself and its own mesentery, causing a closed loop intestinal obstruction that, if not treated, presented complications such as intestinal ischemia, gangrene, and perforation [7].…”

“…On the other hand, the incidence of intestinal volvulus, regardless of the cause and origin, represents variable ranges according to the statistics available; it is reported as 4% of all cases of intestinal obstruction in developed countries and up to 50% of developing countries. Regarding gender distribution, it has been proposed that the predisposition of men to sigmoid colon volvulations is secondary to the fact that the female pelvis has more space for spontaneous reduction of volvulations [7]. A study conducted in the endemic population of Peru showed that fluctuations in temporary rains condition variations in the chances of infection in domestic and human animals [10].…”

“…Clinically, sigmoid volvulus may present acutely with surgical resolution, which may present a high rate of complications with morbidity and added mortality in cases where gangrene occurs or when the patient has significant systemic comorbidities [13], or chronic with intermittent and isolated periods of constipation or occlusion that remits spontaneously, many times without reaching the diagnosis of megacolon or volvulation by resolution without treatment [7].…”

“…The acute clinical picture occurs in approximately 80% of patients [7] and is characterized by sudden abdominal pain and inability to channel gas and stool deposition, conditioning a progressive distention of the abdomen, which in some cases can be asymmetric [10] secondary to the accumulation of gas, fluid, and inflammatory bowel process due to occlusion [3], which increases morbidity [7] and mortality, which can be estimated at 33-80% in cases where intestinal ischemia occurs [17], which can lead to necrosis in three areas mainly in the neck of the volvulus, at any location of the occluded closed loop, and in the portions adjacent to the volvulated area (distal descending colon or proximal rectum by venous thrombosis backward) [6]. Mortality also rises considerably in those with decompensated systemic comorbidities [14].…”

“…Mortality also rises considerably in those with decompensated systemic comorbidities [14]. In a study conducted in India, with a sample of 128 cases of patients with sigmoid volvulus, it was found that 93.75% presented what was considered a classic clinical triad that included abdominal pain, distention, and constipation [7]. According to the time of evolution, the patient may have aggregate symptoms such as nausea and vomiting of gastrointestinal characteristics [18], as well as tachycardia, hypotension, and polypnea, due to the development of systemic inflammatory response syndrome.…”