The diagnosis was made from the history, physical examination, plain abdominal radiograph, and emergency barium enema. Our university hospital is in an endemic area for sigmoid volvulus, and this paper was undertaken to analyze the experience of our clinic in sigmoid volvulus.īetween 19, 81 of 424 patients with acute intestinal obstruction from Cumhuriyet Universitys Department of General Surgery, Sivas, Turkey, had sigmoid colon volvulus. Considerable controversy exists regarding the best method of treatment in the acute situation. Non-operative reduction alone is associated with a high recurrence rate (5). It generally occurs in elderly patients who often have a serious coexisting dis-ease, and has a high mortality when surgically treated (4). Dietary fermentation and gas production contributes to the etiology of sigmoid volvulus. In the Middle East sigmoid volvulus is four times as common as in Western countries (3). In the United States it accounts for 3-5 percent of all cases of intestinal obstruction (2). Bolt found only 28 cases admitted to three British hospitals over a 10-year period (1). It is relatively rare in Western countries. 58050 Sivas, Turkey.Į-mail: colon volvulus, defined as an abnormal twist-ing of the sigmoid colon around its mesentery, is an infrequent cause of colonic obstruction. Rev Esp Enferm Dig 2004 96: 32-35.Ĭorrespondencia: Mustafa Turan. Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process. Turan M, Sen M, Karaday¦ K, Koyuncu A, Topcu O, Y¦ld¦r¦r C, Duman M. There were 9 deaths (21%) among 42 patients who underwent an emergency operation, and one (5.2%) among the 19 patients who had elective surgery died because of a cerebral embolus.Ĭonclusions: initial therapy with endoscopy affords decompression and an adequate preparation of patients for surgical resection, and a flexible colonoscope has notable advantages over rigid instruments for the detortion process. Among the 61 patients undergoing urgent or elective operation for sigmoid volvulus, there were 17 laparotomies laparatomies with only detortion, 19 resections with elective anastomosis, 6 resections with primary anastomosis, and 19 resections with a Hartmanns pouch. In 19 of these 39 non-operatively devolvulated patients, sigmoid resection with primary anastomosis was performed within 7-10 days after reduction, but 20 patients did not accept the elective operation after a non-operative treatment. The success rate of endoscopic detortion for sigmoid colon volvulus with a flexible colonoscope (60%) was higher than with a rigid rectosigmoidoscope (42%). Results: preoperative endoscopic volvulus detortion was attempted in all patients, and in 39 of them the procedure was successful. Methodology: we present our experience of 81 cases of sigmoid volvulus admitted to our department. In this report, we review our experience with sigmoid colon volvulus. Istanbul, Turkeyīackground/aims: the sigmoid colon is the most frequent site for a volvulus. In front, it is separated from the bladder in the male, and the uterus in the female, by some coils of the small intestine.Our sigmoid colon volvulus experience and benefits of colonoscope Lumbar splanchnic nerves provide sympathetic innervation via the inferior mesenteric ganglion.īehind the sigmoid colon are the external iliac vessels, ovary, obturator nerve, the left Piriformis, and left sacral plexus of nerves. Pelvic splanchnic nerves are the primary source for parasympathetic innervation. 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 curving path it takes toward the anus allows it to store gas in the superior arched portion, enabling the colon to expel gas without excreting faeces simultaneously. Its function is to expel solid and gaseous waste from the gastrointestinal tract. It then curves on itself and turns toward the left to reach the middle line at the level of the third piece of the sacrum, where it bends downward and ends in the rectum. The sigmoid colon begins at the superior aperture of the lesser pelvis, where it is continuous with the iliac colon, and passes transversely across the front of the sacrum to the right side of the pelvis.
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