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Sigmoid volvulus in pregnancy
A Togo, M Traore, Y Coulibaly, B Samake, G Diallo
South African Journal of Surgery , 2011,
Abstract: A 27-year-old woman, gravida 1, was seen at our surgical emergency department with abdominal pain at 25 weeks' gestation. She had pain, nausea and vomiting, a temperature of 37°C and a blood pressure of 100/70 mmHg. The cervix was closed, and an ultrasound scan showed a normal single fetus. A plain abdominal radiograph showed distension of the colon and a sigmoid volvulus. At emergency laparotomy, non-gangrenous sigmoid colon was resected with primary anastomosis. There were no complications, and 4 months later the patient delivered a healthy infant. Early diagnosis of sigmoid volvulus in pregnancy and prompt intervention minimise maternal and fetal morbidity and mortality. SAJS, VOL 49, NO. 4, NOVEMBER 2011
Volvulus of the Sigmoid Colon during Pregnancy: A Case Report
Enzo Fabrício Ribeiro Nascimento,Michelle Chechter,Fábio Piovezan Fonte,Nara Puls,Juliana Santos Valenciano,Cláudio Luciano Penna Fernandes Filho,Ronaldo Nonose,Crhistiny Emmanuelle Gabriel Bonassa,Carlos Augusto Real Martinez
Case Reports in Obstetrics and Gynecology , 2012, DOI: 10.1155/2012/641093
Abstract: Colonic obstruction due to sigmoid colon volvulus during pregnancy is a rare but complication with significant maternal and fetal mortality. We describe a case of sigmoid volvulus in a patient with 33 weeks of gestation that developed complete necrosis of the left colon. Case. 27-year-old woman was admitted with 3 days of abdominal distention, vomit, and the stoppage of the passage of gases and feces. She was admitted with poor clinical conditions with septic shock, acute respiratory distress syndrome, and signs of diffuse peritonitis. Abdominal radiography showed severe dilation of the colon with horseshoe signal suggesting a sigmoid volvulus, pneumoperitoneum and we could not we could not identify fetal heartbeats. With a diagnosis of complicate sigmoid volvulus she was underwent to the laparotomy where we found necrosis of all descending colon due to double twist volvulus of the sigmoid. We performed a colectomy with a confection of a proximal colostomy, and closing of the rectal stump. Due to an uncontrollable uterine bleeding during cesarean due, it was required a hysterectomy. The patient had an uneventful postoperative course thereafter and was discharged on a regular diet on the 15th postoperative day.
Volvulus of the Sigmoid Colon during Pregnancy: A Case Report  [PDF]
Enzo Fabrício Ribeiro Nascimento,Michelle Chechter,Fábio Piovezan Fonte,Nara Puls,Juliana Santos Valenciano,Cláudio Luciano Penna Fernandes Filho,Ronaldo Nonose,Crhistiny Emmanuelle Gabriel Bonassa,Carlos Augusto Real Martinez
Case Reports in Obstetrics and Gynecology , 2012, DOI: 10.1155/2012/641093
Abstract: Colonic obstruction due to sigmoid colon volvulus during pregnancy is a rare but complication with significant maternal and fetal mortality. We describe a case of sigmoid volvulus in a patient with 33 weeks of gestation that developed complete necrosis of the left colon. Case. 27-year-old woman was admitted with 3 days of abdominal distention, vomit, and the stoppage of the passage of gases and feces. She was admitted with poor clinical conditions with septic shock, acute respiratory distress syndrome, and signs of diffuse peritonitis. Abdominal radiography showed severe dilation of the colon with horseshoe signal suggesting a sigmoid volvulus, pneumoperitoneum and we could not we could not identify fetal heartbeats. With a diagnosis of complicate sigmoid volvulus she was underwent to the laparotomy where we found necrosis of all descending colon due to double twist volvulus of the sigmoid. We performed a colectomy with a confection of a proximal colostomy, and closing of the rectal stump. Due to an uncontrollable uterine bleeding during cesarean due, it was required a hysterectomy. The patient had an uneventful postoperative course thereafter and was discharged on a regular diet on the 15th postoperative day. 1. Introduction The diagnosis of complicated intestinal obstruction due to sigmoid volvulus (SV) during pregnancy is a rare clinical situation of extreme gravity, because the high rates of maternal and fetal mortality, especially if not recognized and treated precociously [1]. Since the initial report by Braun in 1885, it is estimated that less than 80 cases have been reported in the world literature; however, since 2005, only five cases have been reported [1–7]. Although the incidence of intestinal obstruction in the presence of pregnancy is not well defined, it is estimated that it can be achieved around a 1?:?1,500 to 1?:?66,431 birth cases [8, 9]. The causes of intestinal obstruction during pregnancy are similar to what occurs in their absence: adhesions, abdominal wall hernias, cancer of the left colon, internal hernias, Meckel’s diverticulum, SV, and intussusceptions of sigmoid colon [7, 9]. The SV is the most frequent cause of intestinal obstruction during pregnancy accounting for 25% to 44% of published cases [10–12]. In endemic regions for Chagas disease, as South America, digestive manifestations are common and SV is a possible complication during pregnancy [13]. The main problem of SV in pregnancy is that of delay in presentation and diagnosis. Delay in diagnosis invariably leads to ischemia, necrosis, and perforation of the colon, and
Sigmoid Volvulus  [cached]
S. Selcuk Atamanalp
Eurasian Journal of Medicine , 2010,
Abstract: 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%.
SIGMOID VOLVULUS – CASE PRESENTATION
Maria Gabriela Ro?ca,I. Radu,V. Scripcariu
Jurnalul de Chirurgie , 2008,
Abstract: Background: Sigmoid volvulus the most common type of volvulus of the gastrointestinal tract is the third leading cause of large bowel obstruction. This condition is responsible for 5-7% of all intestinal obstructions. It is particularly common in elderly persons. However, some reports suggest that sigmoid volvulus occurs in younger age-groups more frequently than has been reported. Method: We present the case of a 72 years old patient admitted in our surgical unit in emergency, for an important abdominal distension and colic obstruction. The abdominal X-ray exam diagnosed a sigmoid volvulus. Intraoperative diagnosis was megasigmoid complicated with volvulus; due to the large distention of the colon, a Hartmann procedure has been performed. Postoperative course was uneventful. Conclusions: Although a sigmoid volvulus may present insidiously with chronic abdominal distention, constipation, vague lower abdominal discomfort, and vomiting, this condition is seen more often as an abdominal emergency with acute distention, colic and a failure to pass either flatus or stool. Predisposing factors to sigmoid volvulus include chronic constipation, megacolon, and an excessively mobile colon. Plain abdominal radiograph findings are usually diagnostic. Decompression may be achieved with the introduction of a stiff tube per the rectum, aided by endoscopy or fluoroscopy. Surgical treatment is also indicated (sigmoid resection with colo-rectal anastomosis or Hartamann procedure). Precocious diagnosis and treatment (conservative or surgical) is essential for an uneventful outcome.
Delayed Presentation of Sigmoid Volvulus in a Young Woman  [cached]
Daniel Weingrow,Andrew McCague,Ravi Shah,Fariborz Lalezarzadeh
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2012,
Abstract: Volvulus is an unusual condition in Western countries, generally isolated to elderly patients with multiple comorbidities. This report describes an unusual case of a very large gangrenous sigmoid volvulus in a young, otherwise healthy 25-year-old female. A review of the diagnosis and management is subsequently described. Without a consideration of the atypical demographics for sigmoid volvulus, the case illustrates the potential morbidity due to a delayed diagnosis. Early identification and management are crucial in treating sigmoid volvulus before the appearance of gangrene and necrosis, thereby avoiding further complications and associated mortality. [West J Emerg Med. 2012; 13(1):100–102.]
Predicting Factors for Mortality in Sigmoid Volvulus  [PDF]
Bilsel Ba?,Mustafa Aldemir,?brahim Ta?y?ld?z,Celalettin Kele?
Dicle Medical Journal , 2004,
Abstract: Sigmoid colon is the most frequent site for a volvulus and volvulus of the sigmoid colon(SV) is characterized by a high morbidity and mortality. The objective of this study was toevaluate predicting factors for mortality in the SV cases. Between January 1994 andDecember 2001, the records of patients operated on due to SV at Dicle University Hospital(DUH) were retrospectively reviewed. The epidemiological, clinical, and laboratory featureswere evaluated as probable risk factors for mortality. Variables associated with SV weredetermined using logistic regression models. Of 90 patients, 80 (88.9%) were male, and 10(11.1%) were female. The mean age was 58.8±12.9 (19-85) and 63.6±16.1 (23-83) for thepatients with uneventful outcome (Group 1) and for the patients with fatal outcome (Group2), respectively (p=0.000). The period of symptoms before admission (PSBA) were 2.2±0.73(1-4) days and 5.6±1.7 (2-10) days in Group 1 and Group 2 respectively (p=0.000). While the73.8 % of patients in the Group 1 were operated on an emergency state, 100 % of patients inthe Group 2 were operated on an emergency state (p=0.002). In the univariate analysis, othersignificant risk factors were significantly fluid-electrolyte imbalance, elevated abdominalpressure (EAP), cardiovascular disease, respiratory disease, leukocytosis, hypotension,presence of necrosis, and presence of major contamination (p=0.000). These variables wereentered into the logistic regression model for revealing the risk factors for mortality. Inmultivariate analysis, long PSBA [Odds Ratio (OR) =17.17, 95% Confidence Interval (CI)=2.86-103.07, P=0.002], presence of cardiovascular disease at the admission (OR=0.19,CI=0.001-0.52, P=0.019) and age (OR=0.87, CI=0.77-0.99, P=0.046) were foundsignificantly predictive for mortality. EAP, fluid-electrolyte imbalance, respiratory disease,and presence of major contamination were not statistically significant factors for mortalityafter sigmoid volvulus. In our study, we determined that conditions, such as a long PSBA,presence of cardiovascular disease and age were predicting factors for mortality.
A case of sigmoid volvulus presenting as abdominal distension
Fatimah Lateef,Eunizar Omar
Journal of Emergency Medicine, Trauma and Acute Care , 2012, DOI: 10.5339/jemtac.2012.20
Abstract: Sigmoid volvulus is an important surgical emergency which requires rapid detorsion of the affected bowel. Prompt diagnosis is crucial. It should be one of the differentials to be considered in patients presenting with abdominal distension and signs of intestinal obstruction. This case presentation serves to highlight one such example; the clinical presentation, radiological findings and management are discussed.
Acute Sigmoid Volvulus in a West African Population
A Nuhu, A Jah
West African Journal of Medicine , 2010,
Abstract: BACKGROUND: Acute sigmoid volvulus is one of the commonest causes of benign large bowel obstruction. Its incidence varies considerably from one geographic area to another. OBJECTIVE: To review the management of acute sigmoid volvulus in a relatively high prevalence area. METHODS: All adult patients with acute sigmoid volvulus seen at the Royal Victoria Teaching Hospital (RVTH) Banjul, between September 2000 and January 2005 were studied. Information obtained for analysis from the records included age, sex, clinical features, test results, and outcomes. RESULTS: A total of 48 patients, 45 (93.8%) males and three (6.3%) females, with a male: female ratio of 14.3:1, age range of 19 to 78 years and mean age of 45.8 +17.6 years, underwent treatment for acute sigmoid volvulus. Twenty-one (43.8%) of the patients were aged 40 to 59 years. Two (4.2%) had rectal tube detortion followed by elective sigmoidectomy and primary anastomosis on the same admission, while 24 (50%) had emergency laparotomy at which bowel decompression, onestage resection and primary anastomosis without on-table lavage was done. The rest of the patients, 22 (45.8%) had gangrenous sigmoid colons at laparotomy and consequently had Hartmann's procedure done. Fourteen patients (29.1%) developed wound infection and five (10.4%) had prolonged ileus that was managed conservatively. There was no anastomotic leak. The mean hospital stay was 11.1 days. There were five deaths giving a mortality rate of 10.4%. CONCLUSION: Acute sigmoid volvulus in the Gambia is almost exclusively a male disease. Sigmoid colectomy and primary anastomosis can be carried out safely in those with viable colon without on-table colonic lavage.
Acute sigmoid volvulus in a West African population  [cached]
Nuhu Ali,Jah Abubacar
Annals of African Medicine , 2010,
Abstract: Background: Acute sigmoid volvulus is one of the commonest causes of benign large-bowel obstruction. Its incidence varies considerably from one geographic area to another. This study reviews its management in a relatively high-prevalence area. Materials and Methods: All adult patients with acute sigmoid volvulus seen at the Royal Victoria Teaching Hospital (RVTH), Banjul, between September 2000 and January 2005 were retrospectively studied. Demographic data, clinical features, resuscitative measures, results of investigations, findings at surgery and postoperative course, and complications were retrieved from the patients′ clinical records and analyzed. Results: A total of 48 patients, 45 (93.8%) males and 3 (6.3%) females, with a male: female ratio of 14.3:1, age range of 19 to 78 years and mean age of 45.8 ± 17.6 years underwent treatment for acute sigmoid volvulus. Twenty-one (43.8%) of the patients were aged 40 to 49 years. Two (4.2%) had rectal tube detortion followed by elective sigmoidectomy and primary anastomosis on the same admission, while 24 (50%) had emergency laparotomy, at which bowel decompression, one-stage resection and primary anastomosis without on-table lavage were done. The rest of the patients, 22 (45.8%), had gangrenous sigmoid colons at laparotomy and consequently underwent resection and Hartmann′s procedure. Fourteen (29.1%) patients developed wound infection; and 5 (10.4%) had prolonged ileus, which was managed conservatively. There was no anastomotic leak. The mean hospital stay was 11.1 days. There were 5 deaths, giving a mortality rate of 10.4%. Conclusion: Acute sigmoid volvulus in The Gambia is almost exclusively a male disease. Sigmoid colectomy and primary anastomosis can be carried out safely in those with viable colon without on-table colonic lavage.
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