Sigmoid volvulus

Case contributed by Dr Derek Smith

Presentation

Nursing home patient. Recurrent episodes of constipation with abdominal bloating. Advanced dementia with history of schizophrenia - managed on antipsychotics for a number of years.

Patient Data

Age: 80
Gender: Female
X-ray

Abdominal distention and constipation

Main findings on abdominal radiograph is hugely distended large bowel with a sigmoid loop taking up most of the abdominal space. Other distended large bowel loops adjacent and displaced to patient's left flank.

Apex of this volvulus reaches the right hemidiaphragm in keeping with Chiladiti syndrome. No evidence of perforation.

Incidental fracture of right humeral neck, healed in poor position.

This large sigmoid volvulus was decompressed by rigid sigmoidoscopy.  There was florid bowel activity for 24 hours following this so she was returned to her care home.

Unfortunately, within days, she represented with abdominal distention.

X-ray

Four days after initial presentation

Further examples of large bowel dilatation with sigmoid volvulus.   Patient is poorly rotated in a number of these radiographs through noncompliance.

X-ray

Two weeks after initial presentation

Again another presentation with abdominal distention.  Last abdominal radiograph in keeping with pseudo-obstruction. 

Case Discussion

This case represents a typical presentation of sigmoid volvulus and then pseudo-obstruction.

It also highlights the point that although there was "gas" under the right hemidiaphragm, it was still in the bowel lumen, so there was not a perforation here and this patient did not need to be subjected to CT, surgery, stomas etc....

Despite a number of decompressions with rigid scopes, flatus tubes, and an attempt at colonoscopy, she was not suitable for any surgical intervention so a rectal catheter was kept in place attached to a collecting bag.

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Case information

rID: 34034
Case created: 2nd Feb 2015
Last edited: 4th Oct 2015
Inclusion in quiz mode: Included

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