Sigmoid Volvulus Combined with Hiatus Hernia

Abstract

INTRODUCTION: Sigmoid volvulus is the most common form of gastrointestinal volvulus. A case of sigmoid volvulus combined with hiatus hernia is presented. CASE PRESENTATION: An 81-year-old woman was admitted to the Surgery Department with a history of abdominal pain and distention for several days. The woman arrived from another hospital where chest and abdominal X-rays had been performed. They showed the presence of dilated bowels with some of the bowel loops situated above the right hemidiaphragm. This raised the suspicion of a diaphragmatic rupture. The patient had no history of trauma. On admission to our hospital, abdominal radiogram and computed tomography (CT) were performed. They revealed that the patient had sigmoid volvulus with dilation of the sigmoid colon and the typical `whirl sign` of the twisted sigmoid mesentery. A large hiatus hernia was also found. The entire stomach and a large part of the dilated sigmoid colon turned out to be herniated through the esophageal hiatus into the right hemithorax. The patient underwent surgical detorsion of the sigmoid colon and sigmoidopexy. It was decided that the hiatus hernia should be repaired at a second stage when the patient is stabilized. CONCLUSION: The dilated sigmoid colon in sigmoid volvulus may become herniated into the thoracic cavity when there is a preexisting hiatus hernia. Although a rare co-morbidity, this condition presents certain diagnostic difficulties. Abdominal X-ray and CT have proven to be valuable methods to establish the right diagnosis.