Parkinson’s Disease with Sigmoid Volvulus

Riyazuddin Ansari,Hany Al Hasan

doi:10.5171/2013.624655

Abstract

PARKINSON’s disease is a disorder of somatic motor activity, due to degenerative changes in the basal ganglia. It is a chronic and progressive disorder. Chronic constipation and loss of intestinal tone is the visceral outcome of this disease. These gut manifestations tend to be further aggravated by the drugs used to decrease the somatic muscular rigidity and tremor. The outcome sometimes turns into sigmoid volvulus. The exact etiology of sigmoid volvulus in Parkinson’s disease (PD) remains unclear. Early recognition and treatment of constipation in PD patients may alter complications like sigmoid volvulus. Treatment of sigmoid volvulus in PD patients ranges from endoscopic detorsion to sigmoid colectomy with colostomy.. Herein, we describe an elderly patient with Parkinson’s disease who presented with sigmoid volvulus and underwent colectomy and colostomy.

Highlights

The Sigmoid colon is the frequent site of volvulation and presents with symptoms of constipation, severe abdominal pain, and a distended abdomen
Treatment of sigmoid volvulus in Parkinson’s disease (PD) patients ranges from endoscopic detorsion to sigmoid colectomy with colostomy
We describe a patient known to have PD with past two times of recurrent bowel dilatation associated with sigmoid volvulus, but he was treated conservatively, and again presented with sigmoid volvulus

Summary

Introduction

The Sigmoid colon is the frequent site of volvulation and presents with symptoms of constipation, severe abdominal pain, and a distended abdomen. Respiratory examination was as follows: bilateral equal air entry, and normal vesicular breath sounds. His abdomen was markedly distended, more on the right side. The patient underwent CT scan of the abdomen, which showed (figure 2a) a markedly dilated large bowel loop with inverted U shape, exerting a coffee-bean appearance. Post contrast CT scan abdomen (figure2b) showed markedly dilated large bowel and mainly sigmoid colon, with air-fluid level. The patient was diagnosed with sigmoid volvulus, and he underwent colectomy with colostomy. He was weaned from ventilator and later on discharged from the hospital

Discussion

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Conclusion