Sigmoid volvulus: diagnostic twists and turns

Abstract

The purpose of this study was to describe the clinical profile of patients with sigmoid volvulus and highlight the diagnostic difficulties and pitfalls. This was a retrospective descriptive study of patients with sigmoid volvulus seen at a community hospital over a 5-year period from July 1999 to July 2004. Twenty-eight cases of sigmoid volvulus were identified, of which 16 were male and 12 female. The median age was 74 years. Twenty-seven were Chinese and one was Malay. Seven out of 28 patients were from nursing institutes while the rest came from their own homes. Eleven were bedridden and chronic constipation was a problem for 17 patients. Co-existing medical illnesses, including neuropsychiatric conditions, were common. Abdominal distension and pain were the most frequent presentations (26 and 21 patients, respectively). Twelve patients had constipation and 11 had diarrhoea. Only nine had the complete typical triad of abdominal distension, pain and constipation. The classical coffee-bean sign was identified in nine out of 26 initial plain abdominal radiographs done at the emergency department and a further 11 were diagnosed after review by the surgical team in the ward. Another four were identified only after computed tomography scan of the abdomen and pelvis. The remaining two patients were diagnosed intra-operatively after they underwent emergency laparotomy. As our aged population continues to grow, sigmoid volvulus may be more commonly encountered. Emergency physicians should maintain a high index of suspicion and avoid the pitfalls so as to prevent delay in diagnosis and treatment.