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Sigmoid colon volvulus, also known as sigmoid volvulus, is volvulus affecting the sigmoid colon. It is a common cause of bowel obstruction [ 1 ] and constipation . It is common in Asia, India (7% of intestinal obstruction ) and especially South India because of the high fibre diet.
An ileosigmoid knot or compound volvulus is an uncommon cause of intestinal blockage. [1] The condition arises when ileum loops wrap around the bottom of a redundant sigmoid loop. [ 2 ] In some countries in Africa, Asia, and the Middle East, the ileosigmoid knot is a well-known ailment; this condition is uncommon in the West.
The Hartmann's procedure with a proximal end colostomy or ileostomy is the most common operation carried out by general surgeons for management of malignant obstruction of the distal colon. During this procedure, the lesion is removed, the distal bowel closed intraperitoneally, and the proximal bowel diverted with a stoma .
Volvulus occurs most frequently in middle-aged and elderly men. [11] Volvulus can also arise as a rare complication in persons with redundant colon, a normal anatomic variation resulting in extra colonic loops. [12] Sigmoid volvulus is the most-common form of volvulus of the gastrointestinal tract.
Computed tomography of the abdomen is not routinely necessary, but may show thickening or inflammation in the distal colon (sigmoid colon) with associated diverticulosis. Treatment may consist of antibiotics, aminosalicylates (mesalamine), or prednisone. In rare cases, surgery with segmental resection may be considered.
Benign indications for sigmoidectomy include diverticular disease, especially when complicated by perforation or fistulae, sigmoid volvulus, trauma, and ischemic or infectious colitis. [11] When a sigmoidectomy is followed by terminal colostomy and closure of the rectal stump; it is called a Hartmann operation .
The narrow mesentery predisposes some cases of malrotation to midgut volvulus, a twisting of the entire small bowel that can obstruct the mesenteric blood vessels leading to intestinal ischemia, necrosis, and death if not promptly treated. The fibrous Ladd's bands can constrict the duodenum, leading to intestinal obstruction.
Bowel resection may be performed to treat gastrointestinal cancer, bowel ischemia, necrosis, or obstruction due to scar tissue, volvulus, and hernias. Some patients require ileostomy or colostomy after this procedure as alternative means of excretion. [1]