Diagnosis Of Sigmoid Volvulus Research Articles

Reply to the comments on "Coffee bean sign, steel pan sign and whirl sign in sigmoid volvulus".

We thank Prof. Atamanalp and colleagues for their interest and valuable comments on our article. The authors have highlighted important considerations in the diagnosis of sigmoid volvulus (SV). We would like to respond to their comments. Firstly, although we agree with their opinion that CT, MRI, and endoscopy are more reliable diagnostic tools than plain radiography, we still emphasize that diagnostic imaging for SV is initially based on plain radiography, as recommended by the WSES consensus guidelines. Since SV is the third most common cause of colonic obstruction worldwide, the accessibility of plain radiography is crucial. Among the many plain radiographic signs of SV, Levsky et al. reported that the most sensitive signs were absence of rectal gas, followed by inverted-U appearance and coffee bean sign. Understanding these signs may lead to early detection of SV and further CT evaluation for ischemia or perforation. Despite the high value of plain radiography, there is a global tend to use CT instead from the outset. Secondly, we agree with their opinion that endoscopy is not only a therapeutic, but also a diagnostic procedure to assess mucosal viability. In addition, we believe that endoscopy is also useful in ruling out other obstructive lesions, including colorectal neoplasia and complicated sigmoid diverticular disease. In the clinical setting, endoscopy is performed after the diagnosis of SV by plain radiography or CT and serves as the first line of decompression of SV when ischemia or perforation is not suspected. Finally, we congratulate Prof. Atamanalp and colleagues for their dedicated contribution to the large-scale SV studies in Eastern Anatolia, Turkey, where SV is endemic.

Sigmoid volvulus during pregnancy: A case report and literature review

Background: Sigmoid during in pregnancy is the most common cause of intestinal obstruction. Despitethis, diagnosis remains the largest challenge. The diagnosis of sigmoid volvulus in pregnancy is oftendelayed because the symptoms mimic typical pregnancy-associated complaints. Clinical examination isusually limited because of the gravid uterus, and radiological evaluation presents another challengebecause of the risks of teratogenicity to the fetus, especially in the first trimester. Delays in diagnosisinvariably lead to ischemia, necrosis, and colon perforation, and prompt surgical intervention isnecessary to minimize maternal morbidity and fetal mortality.Case presentation: A 36-year-old para 4+0 gravida 5 presented initially at 29+1 weeks of gestation withabdominal symptoms. A diagnosis of acute gastritis and pyelonephritis was made, and the patient wasallowed home. She later presented with severe abdominal pain and vomiting, after which a diagnosis ofsigmoid volvulus was made at 30+5 weeks of gestation. The patient underwent laparotomy where thevolvulus was detorted. However, she experienced fetal demise in utero two days after the laparotomy.She was induced into labor and expelled the fetus.Conclusion: Sigmoid volvulus complicating pregnancy is rare. However, when it occurs, it may lead toconsiderable maternal and fetal morbidity and mortality. In patients who present with abdominal pain,distension, and absolute constipation, a high index of clinical suspicion is required for prompt diagnosis.Early diagnosis and appropriate surgical intervention are crucial to improve maternal and fetal outcomes,as shown in this case.

Outcomes for sigmoid volvulus managed with and without early definitive surgery: 20-year experience in a tertiary referral centre.

Sigmoid volvulus is rare in Western countries. Patients at risk of sigmoid volvulus are often older with significant co-morbidity. Without sigmoid colectomy there is a high recurrence rate, but indications for surgery are controversial. A retrospective observational study was conducted by reviewing clinical records of patients admitted to Waikato Hospital 1 January 2000 to 1 January 2020 with a diagnosis of sigmoid volvulus. Patient characteristics, clinical features, investigations, management, and outcomes were recorded. One hundred and thirty-two patients (87 male) were included with 203 volvulus episodes. Median age 76 years, median Charlson co-morbidity index (CCI) 4. Median follow-up 11 years. 44/132 (33.3%) had surgery during the index admission, two had elective surgery and the remainder had planned non-operative management. 73/132 (55.3%) had surgery at any stage. 42/86 (48.8%) patients managed non-operatively recurred; 66.7% of recurrences were within 6 months. Forty-three (32.6%) died within 12 months of index admission; 28 (21.2%) died during an admission for volvulus. On univariate analysis higher age and abnormal vital signs were associated with inpatient and 12-month mortality; higher CCI was associated with 12-month mortality. On multi-variate analysis increasing age in years was associated with increased risk of death (HR 1.089 [1.052-1.128, P < 0.001]). Normal vital signs at presentation were associated with decreased risk of death (HR 0.147 [0.065-0.334, P < 0.001]). Sigmoid colectomy should be considered at index presentation with sigmoid volvulus. Half of patients managed non-operatively recurred, with two-thirds recurring within 6 months. The mortality rate remains high for subsequent volvulus episodes.

Sigmoid Volvulus: A Narrative Review and Current Management

Sigmoid volvulus is a common cause of acute intestinal obstruction in older patients and the diagnosis is made by clinical examination and imaging. Sigmoid volvulus can be divided into complicated or uncomplicated clinical presentation. Once the diagnosis of sigmoid volvulus is made, the treatment is initially endoscopic decompression followed by flatus tube insertion. This is followed by surgical intervention which is sigmoid colectomy followed by anastomosis. For complicated sigmoid volvulus, the Hartmann’s procedure is the most common operation. We have conducted this review article to review the current management of sigmoid volvulus.

Synchronous caecal and sigmoid volvulus: a surprise twist.

Traditionally, caecal volvulus (CV) and sigmoid volvulus (SV) have been thought of as largely separate clinical entities with distinct clinical features, radiological findings and treatment strategies. We present a rare case of synchronous CV and SV. To our knowledge, this represents only the ninth such case in the literature. This posed a diagnostic challenge as the seemingly textbook features of SV, such as the classical ‘coffee-bean’ sign on plain abdominal X-ray, masked the simultaneous occurrence of CV which only became apparent after the patient continued to deteriorate despite the successful endoscopic decompression of the SV. The diagnosis of SV should be made cautiously, with a period of close clinical observation post-intervention and a low threshold for re-evaluation should symptoms persist or recur to ensure accurate diagnosis.

Risk factors affecting failure of colonoscopic detorsion for sigmoid colon volvulus: a single center experience.

Colonoscopic detorsion (CD) is the first treatment option for uncomplicated sigmoid volvulus (SV). We aim to examine the factors affecting the failure of CD. The files of patients, treated after diagnosis of SV between January 2015 and September 2020, were retrospectively reviewed. Patients' demographic data, comorbidities, endoscopy reports, and surgical and other treatments were recorded. Patients were divided into two groups, as the successful CD group and unsuccessful CD group. The data were compared between the groups, and multivariate analysis of statistically significant variables was performed. There were 21 patients in the unsuccessful CD group and 52 patients in the successful CD group. The unsuccessful CD rate was found to be 28.76%; this is likely a function of more neuropsychiatric disease, more accompanying sigmoid diverticulum, previous abdominal surgery, abdominal tenderness, onset of symptoms for more than 48 h, higher mean intra-abdominal pressure (IAP), IAP over 15 mmHg, larger mean diameter of the cecum, the cecum diameter over 10 cm, and higher mean C-reactive protein (CRP) values as statistically significant. In the multivariate analysis, previous abdominal surgery and cecum diameter over 10 cm were seen as predictive factors for failure of CD (p=0.049, OR=0.103, and p = 0.028, OR=10.540, respectively). CD failure rate was significantly associated with previous abdominal surgery and a cecum diameter over 10 cm. We found that patients with these factors will tend to need more emergency surgery.

Endoscopic Detorsion Results in Sigmoid Volvulus: Single-Center Experience.

Endoscopic detorsion is the first-line recommended treatment modality in sigmoid volvulus patients who have no peritoneal irritation signs on admission. In this paper, we present the results of endoscopic detorsion procedures applied at the time of presentation with the diagnosis of sigmoid volvulus and review the current literature about this topic.

The Twisted Colon: A Review of Sigmoid Volvulus

In sigmoid volvulus (SV), the sigmoid colon wraps around itself and its mesentery. Sigmoid volvulus accounts for 2% to 50% of all colonic obstructions and has an interesting geographic dispersion. SV generally affects adults, and it is more common in males. The etiology of sigmoid volvulus is multifactorial and controversial; the main symptoms are abdominal pain, distention, and constipation, while the main signs are abdominal distention and tenderness. Routine laboratory findings are not pathognomonic: Plain abdominal X-ray radiographs show a dilated sigmoid colon and multiple small or large intestinal air-fluid levels, and abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy shows a spiral sphincter-like twist of the mucosa. The diagnosis of sigmoid volvulus is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definative or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful nonoperative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%.&#x0D; Journal of Surgical Sciences (2019) Vol. 23(2): 90-94

Sigmoid volvulus in a child

A 10-year-old boy who was previously well presented with sudden onset of intermittent severe abdominal pain, non-bilious vomiting and constipation. Abdominal examination was essentially normal. Abdominal radiographs showed a large dilated loop of the colon with a few air-fluid levels on erect views (A) and supine views displayed a coffee-bean sign (B). Contrast enema was done to exclude other pathologies, which disclosed gradual narrowing of the sigmoid colon up to the level of obstruction, this is termed bird´s beak sign (C). Radiological features were consistent with diagnosis of sigmoid volvulus (SV). The patient was taken to theatre for sigmoidoscopy, which successfully de-rotated SV and elective date for surgery was prearranged. However, the patient presented with recurrence of symptoms 3 weeks later. Urgent laparotomy was performed and 360-degree rotation of sigmoid colon identified (D). The bowel was de-rotated and sigmoid resection with primary anastomosis was performed. There were no complications and the child was asymptomatic at one month follow-up. Histology result of resected sigmoid colon was within normal limits.

Sigmoid volvulus: Comorbidity with sigmoid gangrene.

Sigmoid volvulus (SV) is the wrapping of the sigmoid colon around its mesentery, and sigmoid gangrene is a catastrophic complication of SV. Although the diagnosis of SV is generally not difficult, unfortunately, most of the clinical, laboratory and radiological signs are not pathognomonic in demonstrating sigmoid gangrene. The treatment of gangrenous SV requires emergency surgery. Sigmoid gangrene worsens the prognosis of SV by doubling the mortality rate.

Incidence of Sigmoid Volvulus in Northern Uganda. An Observational Study

Background: Sigmoid volvulus (SV) has a considerable geographical variation in its incidence. The purpose of this study was to determine the incidence of SV in Northern Uganda.Methods:A two year retrospective and one year prospective study in 19 hospitals in Northern Uganda from January 2010 to December 2012 was conducted to determine the incidence of sigmoid volvulus. All patients’ records with a diagnosis of sigmoid volvulus were included in the study. Ethical approval was obtained from the IRB Gulu University and Uganda National Council for Science and Technology (UNCS&T). Data analysis was conducted using STATA/IC version 12.1.Results:The incidence of SV in Northern Uganda was 251.8 per 100,000 surgical population in 2 years. Cases were least observed from May to November and most cases were seen in the dry season from December to April. Conclusions:The incidence of SV in Northern Uganda was 251.8 per 100,000 surgical population in 2 years. The proportion of bowel obstructions due to sigmoid volvulus in Northern Uganda was 23.4% and similarly comparable with the proportion found in other African countries and higher than those indeveloped countries. Keywords : Sigmoid volvulus, incidence

Sigmoid volvulus in children

Fig 1. Abdominal radiograph showing massive dilatation of the whole colon, without signs of intestinal perforation. A 10-YEAR-OLD GIRL was evaluated at the Emergency Department because of a 2-day history of abdominal distension with pain and nonbilious vomiting. She had a 5-year history of chronic constipation, previously diagnosed as functional constipation. On physical examination, her abdomen was massively distended with voluntary guarding. Laboratory evaluation showed an elevated C-reactive protein (24 mg/dL, normal range 0–5 mg/dL). Abdominal radiograph showed a massively dilated colon (Fig 1). A nasogastric tube was placed, and a water-soluble contrast enema was obtained (Fig 2). The enema showed the “twisted taper” or “bird’s beak” configuration of the twisted colon, in which the dilated proximal segment represents the bird’s head, and the tapered distal end its beak. These findings were consistent with the diagnosis of sigmoid volvulus. After an unsuccessful attempt at endoscopic decompression and derotation, the patient underwent an emergency exploratory operation. At laparotomy, 1808 counterclockwise torsion of the sigmoid colon was confirmed. The dilated sigma had a maximal diameter of 17 cm, without sign of ischemia or necrosis. Colonic irrigation with saline solution was performed, and the patient underwent derotation and resection of 25 cm of dilated sigma and primary end-to-end colocolonic anastomosis with sigmoidopexy. Sigmoid volvulus is extremely rare in children and is usually associated with a long-standing history of constipation or pseudo-obstruction. In these patients, redundant sigmoid colon could

Forensic imaging in an unusual postmortem case of sigmoid volvulus

Sigmoid volvulus (SV) is the most common form of intestinal volvulus. It results from a twist at the base of the sigmoid mesentery. The twist causes obstruction of the large bowel and ischemia of the affected portion of the intestine, resulting in necrosis of the intestinal wall, acidosis and subsequent death. While clinical symptoms may vary, they usually include typical signs of a small bowel obstruction, such as nausea, vomiting, and constipation. Some cases of sigmoid volvulus can be more or less clinically silent. Typical radiologic signs of SV are the so-called split-wall sign, the coffee bean sign and the whirlpool sign. In this report, we present the diagnosis of SV in a deceased 52-year-old female, who presented none of the aforementioned clinical key symptoms, using post-mortem computed tomography (PMCT). PMCT examination showed the typical radiologic signs of SV. The findings from the cross-sectional imaging were validated with a traditional autopsy.

Incidence of Sigmoid Volvulus in Northern Uganda: A Cross-Sectional Study Design

Aims: To determine the incidence of sigmoid volvulus in Northern Uganda. Study Design: A cross-sectional (2 years retrospective and one year prospective) study design was conducted on patients’ medical records and those admitted, surgically managed or referred from the 19 hospitals in Northern Uganda. Place and Duration of the Study: This study was conducted in 19 hospitals in Northern Uganda from January 2010 to December 2012. Methodology: A cross sectional study design with a two year retrospective and one year prospective studies were conducted to determine the incidence of sigmoid volvulus in Northern Uganda. All patients’ records with a diagnosis of sigmoid volvulus in 19 hospitals were included in the study. Ethical approval was obtained from the IRB of Gulu University Medical School and Uganda National Council for Science and Technology (UNCS&T). Data analysis was conducted using STATA/IC version 12.1. Results: The incidence of sigmoid volvulus in Northern Uganda was 251.8 per 100,000 surgical populations in 2 years. Most cases occurred in the dry season particularly from December to April and least observed from May to November. Middle aged and elderly male were the most commonly affected. Conclusion: The incidence of sigmoid volvulus in Northern Uganda was 251.8 per 100,000 Original Research Article

Knowledge and attitudes of medical students towards organ donation and transplantation

Knowledge and attitudes of medical students towards organ donation and transplantation

The role of CT and MRI in the diagnosis of sigmoid volvulus

Carbon dioxide (CO2) capture has attracted great interest these days due to the role of CO2 in global warming and its effects in industrial processes. Thus, higher energy efficient and affordable technologies are required for its removal so as to address these problems. In this work, the reaction kinetics of CO2 with 2-amino-2-hyroxymethyl- 1,3-propanediol (AHPD), a sterically hindered amine (SHA), was studied by direct stopped flow method. The aim was to research CO2 absorbent with better CO2 absorption capacity and reaction kinetics than the commonly applied amine solvents. The study was carried out at 288, 298, and 303 K in a concentration range of 0.5-2.0 kmol/m3 of AHPD. Based on the pseudo-first-order for the reaction of CO2, it was found that the reaction can be modeled by a single termolecular reaction mechanism. The reaction rate between CO2 and aqueous solution of AHPD was 9.99, 12.03, and 16.05 m3/kmol.s at 288, 298, and 303 K, respectively, while its activation energy was 31.59 kJ/mol. The results obtained were compared with published reaction rate data of other amines. The present study shows that AHPD is a potential SHA as CO2 absorbent if the reaction rate is enhanced by an additional amine.

Sigmoid Volvulus in 16-year-old Boy with an Associated Anomalous Congenital Band

Sigmoid volvulus, a condition generally seen in debilitated elderly patients, is extremely rare in the pediatric age group. Frequent predisposing conditions that accompany pediatric sigmoid volvulus include intestinal malrotation, omphalomesenteric abnormalities, Hirschsprung's disease, imperforate anus and chronic constipation. A 16-year-old previously healthy African American male presented with a 12 hour history of sudden onset abdominal pain and intractable vomiting. CT was consistent with sigmoid volvulus. A contrast enema did not reduce the volvulus, but it was colonoscopically reduced. Patient condition initially improved after colonoscopy, but he again became distended with abdominal pain, so he was taken to the operating room. On exploratory laparotomy, a band was discovered where the mesenteries of the sigmoid and small bowel adhered and created a narrow fixation point around which the sigmoid twisted. A sigmoidectomy with primary anastomosis was performed. The diagnosis of sigmoid volvulus may be more difficult in children, with barium enema being the most consistently helpful. Seventy percent of cases do not involve an associated congenital problem, suggesting that some pediatric patients may have congenital redundancy of the sigmoid colon and elongation of its mesentery. The congenital band found in our patient was another potential anatomic factor that led to sigmoid volvulus. Pediatric surgeons, accustomed to unusual problems in children, may thus encounter a condition generally found in the debilitated elderly patient.

Contrast-enhanced CT as a preferred diagnostic tool in sigmoid volvulus in a 14-year-old girl

Summary Volvulus of the sigmoid colon is rare in children although it is a common cause of large bowel obstruction in elderly people. We report a case of sigmoid volvulus in a 14-year-old girl with intellectual disability. She had a 1-year history of chronic diarrhea despite supportive treatment. She was brought to the emergency department because of intermittent abdominal pain associated with vomiting of bile and passage of bloody stools. A plain X-ray showed dilated bowel loops. A contrast-enhanced computed tomography (CT) scan showed both limbs of the distended loop tapering in size and forming a round soft-tissue mass with whirled configuration in the left colonic compartment. Preoperatively, volvulus was suspected. Exploratory laparotomy disclosed a markedly distended sigmoid colon packed with fecal material and a counterclockwise rotation of 720 degrees with strangulating gangrene. The volvulus was untwisted, and a 65-cm segmental resection of the colon and primary anastomosis were performed. The patient was discharged on the 19th day following an uneventful postoperative course. We believe that a contrast-enhanced CT scan is a useful tool in the diagnosis of sigmoid volvulus.

Sigmoid volvulus.

In sigmoid volvulus (SV), the sigmoid colon wraps around itself and its mesentery. SV accounts for 2% to 50% of all colonic obstructions and has an interesting geographic dispersion. SV generally affects adults, and it is more common in males. The etiology of SV is multifactorial and controversial; the main symptoms are abdominal pain, distention, and constipation, while the main signs are abdominal distention and tenderness. Routine laboratory findings are not pathognomonic: Plain abdominal X-ray radiographs show a dilated sigmoid colon and multiple small or large intestinal air-fluid levels, and abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy shows a spiral sphincter-like twist of the mucosa. The diagnosis of SV is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definitive or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful non-operative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%.

Ileosigmoid knotting- a rare variant of bowel volvulus

Two patients with acute intestinal obstruction underwent exploratory laparotomy after adequate fluid resuscitation and radiological imaging. A preoperative diagnosis of sigmoid volvulus and an operative diagnosis of ileosigmoid knotting or compound volvulus were established.