Elongated Sigmoid Colon Research Articles

Multiple relapses of sigmoid volvulus in a patient on automated peritoneal dialysis: the role of an elongated sigmoid colon and peritoneal dialysis as potential predisposing factors

Multiple relapses of sigmoid volvulus in a patient on automated peritoneal dialysis: the role of an elongated sigmoid colon and peritoneal dialysis as potential predisposing factors

Treating a Bypass with Bypass Surgery: Repair of a Duodeno-sigmoid Fistula Complicating Acute Diverticulitis.

Diverticular disease is common in Western countries; one-third of patients with diverticular disease develop diverticulitis during their lifetime of whom 5% may experience serious complications. We describe a rare complication of diverticulitis: a duodeno-colic fistula in a patient with an elongated sigmoid colon (dolicosigma). The patient complained of abdominal pain, diarrhea, weight loss, and feculent vomiting. Radiological studies and gastroscopy demonstrated a fistula between the second portion of the duodenum and the sigmoid colon. Curative surgery cured the fistula and completely resolved its associated signs and symptoms.

PROBLEMS OF ACUTE APPENDICITIS DIAGNOSTICS AND SURGICAL TREATMENT

Acute appendicitis is a "chameleon disease" that requires in many cases a complex differential diagnosis. Inflammation of the appendix is one of the most common surgical diseases. Difficulties in the verification of acute appendicitis, the severity of complications associated with late diagnosis indicate that the problems of diagnosis and treatment of this pathology has not lost its relevance. The most difficult question for the surgeon is to diagnose acute appendicitis in time and carry out surgical treatment, prevent all possible complications and minimize the frequency of removal of the unaltered appendix.
 The aim of the study to determine and systematize the causes of difficulties in diagnosing acute appendicitis at the preoperative stage.
 A retrospective analysis of 586 medical records of inpatients who were treated in the surgical department was performed. Among the operated 511 (87.2%) patients, the diagnosis of acute appendicitis before and after surgery coincided, which was confirmed morphologically. In 75 cases, which is 12.8%, the diagnosis of acute appendicitis had atypical symptoms or was masked by the clinic of another pathology.
 Observations of atypical cases of acute appendicitis in combination with other pathologies were the following diseases that occurred under the clinic signs, or combined with them: perforation of the small intestine with fish bone - 4 cases; perforation of Meckel's diverticulum - 2. In one case perforation by a fish bone, in another inflammation with its perforation.
 - terminal ileitis - 1; torsion and necrosis of the fatty suspension of the elongated sigmoid colon - 2; perforation of the diverticulum of the elongated sigmoid colon - 1, rupture of the ovarian cyst - 9 cases, including two children 13 and 17 years; piosalpinx - 2, 1 case of combination of acute calculous cholecystitis with gangrenous appendicitis, which was detected during the audit of the abdominal cavity; inflammatory infiltrate of the omentum - 3; torsion and gangrene of the omentum - 2, a combination of acute appendicitis with omentitis - 8 cases; combination of acute appendicitis with mesoadenitis - 39 cases; rupture of the spleen - 1.
 Conclusions:
 
 Under the clinic of acute appendicitis or in combination with it other acute diseases of the abdominal cavity can mask, up to 12.8%, which are difficult or in some cases impossible to diagnose in the preoperative period.
 One of the reasons for the difficulties of diagnosis is the omission by patients of anamnesis data regarding the onset and course of the disease, as well as alcohol consumption.
 Difficulties in diagnosis occur in children, especially young people, which is 61.3% of cases.
 The combination of acute appendicitis with mesoadenitis was observed in 6.6%. Among these patients, acetonemic syndrome was observed in 87.2% of cases. This group of patients is dominated by children.
 Gynecological diseases are disguised under the clinic of acute appendicitis in 1.9%, which requires a joint examination by a surgeon and obstetrician-gynecologist of patients with suspected acute appendicitis in the preoperative period.
 Deciding on surgical treatment for suspected acute appendicitis is a clinic of acute peritonitis, which was observed in 63.3%, requires proper clinical thinking of the surgeon combined with experience, laboratory and instrumental examination.

The use of dynamic MR imaging in patients with clinical pelvic floor disorders.

To determine the differences and challenging aspects of dynamic magnetic resonance defecography (MRD) compared to conventional defecography (CD) in diagnostic of clinical symptomatic pelvic floor dysfunction. Fifty patients (44 females, 6 males; mean age: 57years) with symptomatic pelvic floor dysfunction underwent both examinations, CD and MRD. Results were retrospectively intra-individual and interindividual evaluated in this multicentre study. Visibility and accuracy in diagnosis and classification of rectal prolapse, rectocele, enterocele, sigma diverticula and Cul-de-sac phenomenon/syndrome were observed. Differences were analysed using Mann-Whitney U test. P-values<0.05 were considered as statistically significant. CD was significantly superior to MRD in diagnosis and grading of rectal prolapse (p<.001), diagnosis and metric measurements of rectoceles (p=.016), diagnosis of elongated sigmoid colon (p=.008) and Cul-de-sac phenomenon and syndrome, respectively (p=.015; p=.008). MRD revealed equal results to CD in detection, localization, tendency to retention and enlargement of rectoceles (p=.337) and findings of enteroceles (p=.604) as well as sigma diverticula (p=.149). The complementary use of both examination methods, CD and MRD, is important to achieve a comprehensive look on every aspect of pelvic floor disorders and gain optimal results in detection and evaluation of all major disorders of the pelvic floor.

Abdominal compartment syndrome due to extremely elongated sigmoid colon and rectum plus fecal impaction caused by disuse syndrome and diabetic neuropathy: a case report and review of the literature

BackgroundAbdominal compartment syndrome (ACS) is defined as a sustained raised level of intra-abdominal pressure more than 20 mmHg with or without abdominal perfusion pressure less than 60 mmHg and the development of new end-organ failure. Abdominal surgery, major trauma, volvulus, ileus, distended abdomen, fecal impaction, acute pancreatitis, liver dysfunction, sepsis, shock, obesity, and age have all been reported as risk factors. Herein, we report the severest known case of ACS due to extremely elongated sigmoid colon and rectum plus fecal impaction caused by disuse syndrome and diabetic neuropathy, together with a brief review of the literature.Case presentationA 48-year-old Asian man suffering from shock was transported by ambulance to our hospital. His medical history included hypoglycemic encephalopathy sequelae, disuse syndrome, type 2 diabetic neuropathy, and constipation. He recovered consciousness in the ambulance, and his physical examination as well as laboratory findings were normal. X-ray and dynamic computed tomography revealed a thickened gut wall, and an extremely dilated sigmoid colon and rectum filled with a massive amount of stool as well as gas, compressing other intra-abdominal organs. We diagnosed the patient with transient vasovagal syncope, together with ACS, due to extremely elongated sigmoid colon and rectum plus fecal impaction, caused by anorectal disturbance derived from disuse syndrome and diabetic neuropathy. We first repeated stool extraction for bowel decompression and he subsequently became symptom-free, after which we performed a colostomy on the 28th hospital day. The postoperative course was uncomplicated, and he was discharged on the 44th hospital day.ConclusionsClinicians need to keep ACS in mind as a differential diagnosis and perform careful and detailed examination when encountering patients presenting with symptoms or risk factors of ACS. In addition, they need to precisely diagnose ACS and perform optimal treatment without delay.

A Case of Severe Constipation Due to Elongated Sigmoid Colon After Correction of Anocutaneous Fistula, Which Was Successfully Treated by Sigmoidectomy

A Case of Severe Constipation Due to Elongated Sigmoid Colon After Correction of Anocutaneous Fistula, Which Was Successfully Treated by Sigmoidectomy

Full colonoscopy in patients under 50 years old with lower gastrointestinal bleeding.

Background:Lower gastrointestinal (GI) bleeding is a common clinical problem in young patients. The management of this disease in patients is challenging. The aim of this study is to compare sigmoidoscopy with full colonoscopy in these patients.Materials and Methods:In this cross-sectional study, 120 eligible patients under 50 years old with acute rectal bleeding were enrolled. After cleaning the colon, initially the patients underwent sigmoidoscopy. Pain, the comfort of the test by physician and patient, duration of the procedure, and pathologic findings were recorded. The procedure continued until the splenic flexure passed in the ileocecal valve, and this stage was considered as proximal colonoscopy. Pain, easy performance by physician and the patient, duration of procedure, and pathologic findings were recorded in this stage too. The variables in the two stages were compared with each other.Results:There were 66 women (55%) and 54 men (45%) and the mean of age was 41 ± 7.9 years. Proximal colonoscopy from splenic flexure to reach cecum was relatively easier for the physician and the patient than sigmoidoscopy (P < 0.001). Furthermore, the time spent to carry out proximal colonoscopy was less than the time taken for sigmoidoscopy (P < 0.001). Pathologic findings recorded in full colonoscopy were more than sigmoidoscopy (P < 0.001). Therefore, full colonoscopy that includes sigmoidoscopy and proximal colonoscopy is relatively easier than sigmoidoscopy for patients, and it also proves more advantageous than sigmoidoscopy for physicians to perform in Iranian patients because of more tortuous and elongated sigmoid colon in these patients.Conclusion:It is advised to perform full colonoscopy than sigmoidoscopy in young patients with lower GI bleeding.

The morphology of the foetal sigmoid colon in the African population: a possible predisposition to sigmoid volvulus.

This study aimed to determine the morphological types of the foetal sigmoid colon and establish if the anatomical predisposition to sigmoid volvulus is present in Black African foetuses. Sigmoid volvulus affects Black Africans in our province more frequently than other ethnic groups, and males more than females. Its aetiology remains speculative, with factors being proposed that do not suggest the pathogenetic mechanisms or the gender bias. Previous anatomical studies have suggested that Black Africans have a predisposition to sigmoid volvulus due to an elongated sigmoid colon. We investigated whether this phenomenon occurred during foetal development. Foetuses were donated from local hospitals. Population groups were defined as Black African and non-African. After dissection, the anatomy of the sigmoid colon was described according to level of origin, classic or elongated type and shape (broad or narrow). A total of 296 Black African foetuses and 37 non-African foetuses were donated. The sigmoid colon in the majority of foetuses in all gestational age groups had a low level of origin. An elongated colon was seen in 68% of Black African and 17% of non-African foetuses (P < 0.0001). Among Black Africans there was a higher proportion of elongated sigmoid colon among male (73%) than female foetuses (62%) (P = 0.044). In foetuses with an elongated sigmoid colon the broad shape was more common in females than males and the long-narrow shape was more common in males (P = 0.038). The elongated sigmoid colon seen in Black Africans is present in utero and occurs more frequently in Black African males. A narrow shape is more common in male foetuses and the broad shape is more common in female foetuses. These anatomical features may be the cause of the predisposition to sigmoid volvulus in Black African adults.

Role of the enteric nervous system in the elongated sigmoid colon of patients with sigmoid volvulus.

To clarify the physiologic function of the enteric nervous system (ENS) in the elongated sigmoid colon (ESC) of patients with sigmoid volvulus (SV), we examined the enteric nerve responses in lesional and normal longitudinal muscle strips (LMS) derived from patients with ESC and patients who underwent colon resection for colonic cancers. Thirty preparations of LMS were taken from the lesional sigmoid colons of 10 ESC patients with SV (8 men and 2 women, aged 53 to 80 years, mean 66.2 years). Forty preparations of LMS were taken from the normal sigmoid colons (NSC) of 20 patients with colonic cancer (12 men and 8 women, aged 55 to 76 years, mean 62.3 years). A mechanographic technique was used to evaluate in vitro muscle responses to electrical field stimulation (EFS) before and after treatment with various autonomic nerve blockers. Response to EFS before blockade of the adrenergic and cholinergic nerves was as follows: NSC and ESC significantly demonstrated relaxation reaction rather than contraction reaction (P = 0.0253, P < 0.0001, respectively). ESC showed relaxation reaction more than NSC (P = 0.1138). Response to EFS after blockade of the adrenergic and cholinergic nerves was as follows: NSC and ESC significantly demonstrated relaxation reaction via nonadrenergic noncholinergic (NANC) inhibitory nerves rather than contraction reaction via NANC excitatory nerves (P < 0.0001, P < 0.0001, respectively). ESC with SV significantly showed relaxation reaction more than NSC (P = 0.0092). An increased response of relaxation mediated NANC inhibitory nerves may play a role in impaired motility in the ESC of patients with SV.

Radiological anatomy of the sigmoid colon

The variable incidence of sigmoid volvulus, which depends on the presence of an elongated sigmoid colon, suggests the possibility of variations in the length of the sigmoid colon. This study was undertaken among the three major population groups to prove this hypothesis. Radiological films of patients of the three population groups (African, Indian and White) undergoing barium enema were reviewed. The stature was measured by the distance from T12 to L4. The collective length of the rectum and sigmoid colon as well as the entire colon was measured on the barium enema film using an opisometer. Measurement was from the upper border of the symphysis pubis to the upper border of the left iliac crest. The level of the apex of the sigmoid colon loop and its redundancy were also assessed. There were 109 patients (61 females) undergoing barium enema (39 Africans, 49 Indians, and 21 Whites). For the entire group the T12-L4 distance was 16.6 +/- 2.2 cm and the entire colon length was 133 cm (range 88-262 cm) and was significantly longer among African patients (P = 0.003). The combined length of the rectum and sigmoid colon was 48.8 +/- 15.7 cm (Africans 60.9 +/- 14.4 cm, Indians 41.3 +/- 12.2 cm and Whites 44 +/- 11.6 cm). The sigmoid colon was significantly more redundant in Africans (90%), compared to Indians (25%) and Whites (24%) (P = 0.003 for Indians and P = 0.048 for whites). The apex of the sigmoid colon reached L1-L3 in 54% among Africans, 6% among Indians and in 10% among Whites (10%). African patients had the longest combined length of the rectum and sigmoid colon translating into a long sigmoid colon. They also had the highest number of redundant sigmoid colon. This may explain the high incidence of sigmoid volvulus in African patients.

Ileosigmoid knotting in a child: The first case report in a French girl

Ileosigmoid knotting occurs when the ileum wraps around the base of an elongated sigmoid colon. It is rare in developed countries, especially in children. The authors report the first case of ileosigmoid knotting in a Caucasian French girl.

TWO CASES OF SIGMOID VOLVULUS IN CHILDHOOD

Two cases of sigmoid volvulus which is a relatively rare entity are reported. ‹Case 1› A 12-year-old girl was admitted to the hospital because of abdominal distension. On physical examination, her general condition was quite good. Sigmoid volvulus was diagnosed by means of plain abdominal X-ray and barium enema examinations. A colonoscope was used successfully to reduce the volvulus. One year later, however, recurrence of the volvulus occurred, and a resection of the elongated sigmoid colon with anastomosis was performed. She is doing well as of seven years after the operation. ‹Case 2› A 9-year-old girl was admitted to the hospital because of severe abdominal pain. On physical examination, the abdomen severely distended and there were diffuse tenderness and muscular defense. Laboratory data demonstrated leucocytosis and metabolic acidosis. Sigmoid volvulus was diagnosed by means of plain abdominal X-ray and barium enema examinations. At an emergency laparotomy, the elongated sigmoid colon was twisted clockwise by 360 degree, causing necrosis. The necrotic sigmoid colon was resected, and a colostomy was established by using the cut end of the sigmoid colon. Three months later, the continuity of the colon was reestablished. She is doing well as of two years after the operation.

A CASE OF SIGMOID MEGACOLON DUE TO CHRONIC INTERMITTENT SIGMOID VOLVULUS SECONDARY TO MESENTERIUM COMMUNE WITH NON-FLXATION OF THE DESCENDING COLON

We report a case of sigmoid megacolon due to mesenterium commune with non-fixation of the descending colon. A 24-year-old woman was seen at the hospital because of abdominal pain and abdominal fullness. Barium enema showed that the dilated and elongated sigmoid colon was slightly twisted by the movement of the descending colon with changes in body position. The patient was diagnosed as having a sigmoid megacolon caused by chronic intermittent volvulus of the sigmoid colon and was operated on. At laparotomy, the sigmoid colon dilated and elongated, and the ascending colon only partly fixed to the retroperitoneum. The descending colon completely unfixed to the retroperitoneum, so the left hemicolon could be lifted out of the abdomen. Resection of the dilated sigmoid colon was performed with end-to-end anastomosis. Histopathological examination revealed that the ganglion cells of the sigmoid colon were normal, as were the mucous membrane, submucosa, and muscle layer. Sigmoid megacolon or volvulus of the sigmoid colon due to mesenterium commune with non-fixation of the descending colon occurs rarely and this is the fourth report in the Japanese literature.