The twisted colon: a review of sigmoid volvulus

Sigmoid volvulus (SV) is the third leading cause of colon obstruction in adults. In infants and children, it is exceedingly rare with only sporadic cases reported so far. SVs from secondary causes, with congenital megacolon being the most important, are nevertheless more common in young people. The...

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Bibliographic Details
Published in:The American surgeon 2012-03, Vol.78 (3), p.271-279
Main Authors: Osiro, Stephen B, Cunningham, Debbie, Shoja, Mohammadali M, Tubbs, R Shane, Gielecki, Jerzy, Loukas, Marios
Format: Article
Language:English
Subjects:
Abdomen
Adult
Child
Colon
Comorbidity
Constipation
Developing countries
Diagnostic Imaging - methods
Female
Global Health
Humans
Infant
Intestinal Obstruction - epidemiology
Intestinal Obstruction - prevention & control
Intestinal Volvulus - diagnosis
Intestinal Volvulus - epidemiology
Intestinal Volvulus - surgery
Laparoscopy
LDCs
Male
Mortality
Pain
Prevalence
Prognosis
Sigmoid Diseases - diagnosis
Sigmoid Diseases - epidemiology
Sigmoid Diseases - surgery
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Summary:Sigmoid volvulus (SV) is the third leading cause of colon obstruction in adults. In infants and children, it is exceedingly rare with only sporadic cases reported so far. SVs from secondary causes, with congenital megacolon being the most important, are nevertheless more common in young people. The etiology of this disorder is not completely understood. It is known to occur in the setting of redundant sigmoid loop, which rotates around its narrow and elongated mesentery. Although the latter occurs in the setting of constipation, a congenitally elongated colon, and other predisposing factors, there is no consensus on the precipitating factor leading to SV formation. The symptoms are suggestive of small bowel obstruction, but the presentations can be acute or indolent. Plain abdominal radiography is used to diagnose SV in most cases with computed tomography scan or magnetic resonance imaging as the confirmatory tests when necessary. After it has been untwisted, the definitive and standard therapy for SV is sigmoid resection and primary anastomosis. The nonresective alternatives have also been widely used with mixed success, but a large, randomized controlled trial is needed to compare their efficacy with resection and primary anastomosis. Laparoscopic surgery in SV management is unwarranted and costly. Complications of SV include hemorrhagic infarction, perforation, septic shock, and death. The mortality data from SV vary, but the latest literature cites an overall range of 14 to 45 per cent.
ISSN:0003-1348
1555-9823