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Sigmoid colon volvulus, also known as sigmoid volvulus, is volvulus affecting the sigmoid colon. It is a common cause of bowel obstruction [ 1 ] and constipation . It is common in Asia, India (7% of intestinal obstruction ) and especially South India because of the high fibre diet.
In a cecal volvulus, the cecum may be returned to a normal position and sutured in place, a procedure known as cecopexy. [1] If identified early, before presumed intestinal wall ischemia has resulted in tissue breakdown and necrosis, the cecal volvulus can be detorsed laparoscopically. [ 18 ]
An ileosigmoid knot or compound volvulus is an uncommon cause of intestinal blockage. [1] The condition arises when ileum loops wrap around the bottom of a redundant sigmoid loop. [ 2 ] In some countries in Africa, Asia, and the Middle East, the ileosigmoid knot is a well-known ailment; this condition is uncommon in the West.
Localized ahaustral distended colon can be seen on abdominal x-ray during obstruction or volvulus. Sigmoidal volvolus , more often seen in psychiatric and neurologically impaired patients (e.g. Parkinson's disease ), shows lack of haustra on x-ray and points from the pelvis to the right upper quadrant just below the diaphragm.
The sigmoid colon is completely surrounded by peritoneum (and thus is not retroperitoneal), which forms a mesentery (sigmoid mesocolon), which diminishes in length from the center toward the ends of the loop, where it disappears, so that the loop is fixed at its junctions with the iliac colon and rectum, but enjoys a considerable range of movement in its central portion.
The small and large bowels are placed in a position that reduces their risk of future volvulus; With this condition the appendix is often on the wrong side of the body and therefore removed as a precautionary measure during the surgical procedure. This surgical technique is known as the "Ladd's procedure", after Dr. William Ladd.
Volvulus [24] Sigmoid colon volvulus: Abdominal pain (>2 days, distention, constipation) Cecal volvulus: Abdominal pain (acute onset), nausea, vomiting Clinical (history and physical exam) Imaging (abdominal X-ray or CT) Sigmoid: Gastroenterology consultation (flexibile sigmoidoscopy) Cecal: General surgery consultation (right hemicolectomy)
A proctosigmoidectomy, Hartmann's operation or Hartmann's procedure is the surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy. It was used to treat colon cancer or inflammation (proctosigmoiditis, proctitis, diverticulitis , volvulus , etc.).