The role of sigmoid colon anatomic dimensions in the development of sigmoid volvulus, North-Western Ethiopia

Abstract

Introduction Sigmoid colon anatomic dimensions have been studied to have roles in the occurrence of sigmoid volvulus; however, these studies are few in number and failed to control the confounding effect of acute sigmoid obstruction on the anatomic dimensions. The main objective of this study was to assess the role of sigmoid colon anatomic dimensions in the development of sigmoid volvulus controlling the effect of acute sigmoid obstruction on the anatomic dimensions. Materials and methods The study was carried out from Dec, 2019 to April, 2021 at Tibebe Ghion Specialized Hospital and Felege Hiwot Comprehensive Specialized Hospital, two referral hospitals in Bahir Dar city, North-Western Ethiopia to compare sigmoid anatomic dimensions among three independent groups of participants: patients with no history of sigmoid volvulus (I), those for whom elective surgery was done after non-surgical detorsion of sigmoid volvulus (II), and patients for whom emergency surgery was done for sigmoid volvulus (III). The anatomic dimensions were compared using fixed effects one-way ANOVA or Kruskal-Wallis H test at p-value ≤ .05 (two-sided) and Tukey method or Dunn-Bonferroni’s test was used for post-hoc comparisons. Results A total of 66 consecutive eligible patients (22 for each of the three groups) were included and analyzed in the study. The means of anatomic dimensions (in cm) for groups (I, II, III) were: sigmoid colon length-SCL (35.91, 71.07, 80.86), meso-sigmoid height-MSH (17.11, 26.52, 28.86), meso-sigmoid maximal width-MSMW (9.70, 14.89,16.80), and meso-sigmoid root width-MSRW (8.34, 7.48, 8.11). SCL, MSH, MSMW, MSH/MSRW, and MSMW/MSRW were found to be statistically significantly different in patients with sigmoid volvulus. MSRW and MSH/MSMW were not different between the study groups. Conclusion A long sigmoid colon with long and wide mesentery, but with a constant base is highly likely to predispose individuals to sigmoid volvulus.

Mediastinal and tracheal shift due to recurrent sigmoid volvulus: A case report

“…One study suggests that individuals with a long sigmoid colon and a long mesentery with a narrow base are at a higher risk of developing sigmoid volvulus. 8 Other factors, such as Hirschsprung disease, neurologic disorders, prolonged constipation, or megacolon, can also contribute to the occurrence of sigmoid volvulus. 9 …”

Sigmoid volvulus and concomitant clinical entities

“…[9,10] The presence of the dolichosigmoid is regarded as the main anatomical predisposition in the development of SV by making the twisting easier. [11,12] The sigmoid colon is a dynamic organ, which occasionally twists and untwists. Rotations less than 180°are physiological, which frequently resolves spontaneously.…”

“…[17] Contrary to the dolichosigmoid anatomy of the sigmoid colon in males, brachiosigmoid (a normal-sized sigmoid colon with a mesentery wider than longer) is common in females, which makes the twisting difficult. [1,10,11,15] Another important factor is the presence of a large pelvis with a lax abdominal wall in females, which makes the untwisting easier. [2,17] High concentration of undigested fiber arising from high-fiber and vegetable diet habit leads to bulky stool and fecal loading, which increases intraluminal pressure and worsens the elastogenesis of the colonic wall resulting in dolichosigmoid in time.…”

“…[17] Contrary to the dolichosigmoid anatomy of the sigmoid colon in males, brachiosigmoid (a normal-sized sigmoid colon with a mesentery wider than longer) is common in females, which makes the twisting difficult. [1,10,11,15] Another important factor is the presence of a large pelvis with a lax abdominal wall in females, which makes the untwisting easier. [2,17]…”

Management of Sigmoid Volvulus: A Literature Review

“…2,5,9,10,13,17,19,20,24,27,28 Recurrence An elongated and dilated sigmoid colon with a long mesentery, dolichosigmoid, is the main factor in the development of both primary and recurrent SV. 15,23,[28][29][30][31][32] Other factors affecting recurrence are advanced age, male gender, early onset, highfiber diet, high altitude, and chronic constipation. 29 Although the extension of the sigmoid colon to the subphrenic space and the decrease of left lateral hepatic section volume are suspected as recurrence-augmentative findings in computed tomography, increased maximal sigmoid colon distention is the most effective precursor relating to dolichosigmoid.…”