Epidemiology, Clinical features and Treatment of Sigmoid Volvulus

Execution time: It was from 23/2/1393 up to 23/2/1399, but according to some factors, it’s postponement.

Name of researcher: Dr. Mohammad Hassan Sayee. Specialty: General Surgery. Scientific ranking: Associate Professor.

Manner of Scientific research subject completion: Individual.

Sigmoid volvulus is a life-threatening surgical emergency which demands early surgical intervention. It is a condition which, the sigmoid colon wraps around itself and its own mesentery, and causing a closed-loop obstruction which, if left untreated, often results in life threatening complications, such as, bowel ischemia, gangrene, perforation, sepsis, and death. This disease is prevalent all over the world and both sexes can be involved, but more common in males. In developed countries, sigmoid volvulus is measured as a third cause of large intestine obstructions following cancer and diverticular disease and it is usually twisted in anticlockwise direction.  If the twisting of the bowel on its mesenteric axis greater than 180 degrees, it will produce an obstruction of the intestinal lumen and mesenteric vessels.

The etiology of sigmoid volvulus is multifactorial and controversial. It is generally a disease of elderly males, but can occur in neonates to young individuals. The people who have a long sigmoid colon with a narrow base of mesenteric attachment, would be more prone to volvulus. Anatomical predispositions, advanced age, a high-fiber diet, male sex, medications altering intestinal motility, chronic constipation, neurological or psychiatric illness, bedridden or debilitating status, Chagas’ disease, pregnancy, previous abdominal surgeries, Hirschsprung’s disease, and megacolon have all been reported in association with development of this condition.

The diagnosis of acute sigmoid volvulus is established by clinical and radiological findings, but it is difficult to differentiate gangrenous and non-gangrenous bowel pre-operatively. In the majority of patients, a complete physical examination and abdominal radiographs are adequate to achieve the diagnosis. Typical symptoms include sudden abdominal pain and distension followed by obstipation. The most common signs are abdominal tenderness and asymmetrical abdominal distention. Plain radiographs are diagnostic in 57% - 90% of patients.

Based on current knowledge, primary prevention is not possible. The twist may get spontaneously reduced or early detorsion is performed by non-operative procedure. Delay in reduction may lead to strangulation or gangrene. Nonoperative detorsion is advocated as the primary treatment choice in uncomplicated acute sigmoid volvulus. Although rectal tubes, barium enemas or rigid sigmoidoscopy have been widely used, and flexible sigmoidoscopy is now the preferred nonoperative procedure, but there is a fear of compromised vascular supply of the sigmoid colon, therefor, immediate laparotomy after resuscitation must be undertaken to avoid gangrene and septic shock. Even following conservative detorsion, elective sigmoidectomy is advocated due to high rates of recurrence.

In relation to the importance and urgency of research subject, I should point; since description of sigmoid colon volvulus in 1836 by von Rokitansky, despite of advances in surgical treatment, it has remained as a formidable disease fraught with innumerable complications and responsible for many deaths. From the other side, predisposing factors, epidemiology, clinical feature and treatments facilities of sigmoid volvulus are somedeal different in different parts of the world, and as yet, there is no widespread research in relation to this subject in our country, therefor, according to the importance and urgency of this subject, Medical Science Center of Academy of Science of Afghanistan are amenable me, to perform research around “Epidemiology, Clinical features and Treatment of Sigmoid Volvulus”.

Goal of research: In this research, pursuit the following goals:

- Finding of number and percentage of Sigmoid Volvulus according to sex in different ages.

- Finding of relation between disease and occupation.

- Study of predisposing factors for disease.

- Study of clinical features of disease.

- Study of different treatment methods for Sigmoid Volvulus.

- Finding of more effective and more prevalent surgical treatment for Sigmoid Volvulus.