Sigmoid Volvulus

Question 1

Vomiting, abdominal pain and distension, Constipation. Decreased Na+, ABG: pH 7.5. Patient clinically dehydrated, AXR: Volvulus
How will you manage

Who are you going to involve in the patients care?
Risk factors for developing volvulus

Surgical options for a patient with sigmoid volvulus?

Complications of sigmoid volvulus?

Clinical picture of sigmoid volvulus?

Answer 1

• I would manage the patient according to CCrISP protocol (ABC)
• Keep NBM, NG tube
• Catheter and fluid balance chart
• IV access
• Start IV fluid (Normal saline + Kcl)
• Monitor vital signs
• Early detorsion with rigid sigmoidoscopy +/- insertion of flatus tube (rectal tube)
• Followed by elective surgery to correct underlying cause

• Constipation
• Abdominal distension
• Abdominal pain
• Late vomiting (Feculent vomiting)
• Dehydration, secondary to fluid third spacing + vomiting tachycardia, hypotension, oliguria

• Bowel ischemia and gangrene
• Perforation
• Peritonitis and sepsis

• General Surgeon/Colorectal Surgeon
• Anesthetist
• ITU

• Labrotomy with manual detortion and assess for viability. If viable
do sigmoidopexy to the lateral wall of abdomen or pelvis
• Hartmann’s procedure with end colostomy or PaulMikulicz procedure

Q: What are the risk factors for developing sigmoid volvulus?
• Increasing age
• Neuropsychiatric disorders
• Resident in a nursing home
• Chronic constipation or laxative use
• Male gender
• Previous abdominal operations