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medications from chronic psychiatric conditions (e.g. chronic schizophrenia)
Symptoms are that of large bowel obstruction: constipation, abdominal bloating, nausea and/or vomiting. Onset may be acute or chronic.
There is a wide range of causes; some are geographically specific 5:
chronic constipation and/or laxative abuse
fiber-rich diet (especially in Africa)
Chagas disease (especially in South America)
Abdominal radiographs will show a large, dilated loop of the colon, often with a few gas-fluid levels. Specific signs include:
Frimann-Dahl sign - three dense lines converge towards the site of obstruction
absent rectal gas 5
Although now uncommonly performed, a water-soluble contrast enema exquisitely demonstrates this condition, with the appearances described as the beak sign (or bird beak sign).
whirl sign: twisting of the mesentery and mesenteric vessels
bird beak sign: if rectal contrast has been administered 6
X-marks-the-spot sign: crossing loops of bowel at the site of the transition
split wall sign: mesenteric fat seen indenting or invaginating the wall of the bowel
steel pan sign: a close resemblance to the percussion instrument known as a steelpan 9,10
Treatment and prognosis
Endoscopic detorsion (e.g. rigid/flexible sigmoidoscopy, colonoscopy) in sigmoid volvulus cases without ischemia or perforation successfully treats ~80% (range 60-95%) of patients and is recommended as the initial treatment 8. Occasionally patients suffer from recurrent sigmoid volvulus, for which a surgeon may consider sigmoid colopexy (surgical fixation of the sigmoid colon), or in the surgically unfit, a percutaneous endoscopic colostomy (PEC) might be performed.
The mortality rate is 20-25% 7. The most serious complication is bowel ischemia.
History and etymology
Von Rokitansky described sigmoid volvulus for the first time in 1836 9.
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- 8. Clinical Practice Guidelines for Colon Volvulus and Acute Colonic Pseudo-Obstruction. (2016) Diseases of the Colon & Rectum. 59 (7): 589. doi:10.1097/DCR.0000000000000602 - Pubmed
- 9. Muhammad Sohaib Asghar, Abubakar Tauseef, Hiba Shariq, Maryam Zafar, Rumael Jawed, Uzma Rasheed, Mustafa Dawood, Haris Alvi, Saad Aslam, Marium Tauseef. Sigmoid volvulus: a rare but unique complication of enteric fever. (2020) Journal of Community Hospital Internal Medicine Perspectives. doi:10.1080/20009666.2020.1718480
- 10. Singh Y, Islam S, Arra A, Banfield R, Naraynsingh V. The steel pan sign of sigmoid volvulus-A case series. (2017) International journal of surgery case reports. 41: 332-335. doi:10.1016/j.ijscr.2017.10.064 - Pubmed
- 11. Bettina Lieske & Catiele Antunes. Sigmoid Volvulus. StatPearls Publishing. 2022. https://www.ncbi.nlm.nih.gov/books/NBK441925/ - Pubmed