Diagnosis and Treatment of the Sigmoid Colon Volvulus As a Form of Colonic Obstruction

Abstract

Relevance. Intestinal obstruction can occur in all age groups, but most often it occurs at the age of 40–70 years and one of the causes of colonic obstruction may be volvulus of the sigmoid or cecum. Volvulus of the sigmoid colon is most common and reaches 15% of all types of strangulation intestinal obstruction. The mortality rate in sigmoid colon volvulus reaches 14–16%. In cases of necrosis of the sigmoid colon, the mortality can reach 70–78%.Aim of study. To evaluate the results of diagnosis and treatment of patients with sigmoid volvulus.Material and methods. In 2015–2020 at the N.V. Sklifosovsky Research Institute for Emergency Medicine we treated 28 patients with volvulus of the sigmoid colon. Of these, there were 13 women (46.4%) and 15 men (53.6%). The average age of the patients was 69 years. Upon admission to the hospital, patients underwent a clinical examination, basic laboratory and instrumental methods of examination. If volvulus of the sigmoid colon was suspected, colonoscopy, irrigoscopy, computed tomography of the abdominal organs with contrast enhancement, and diagnostic laparoscopy were additionally performed. In the department, patients underwent fluid maintenance, antispasmodic and symptomatic therapy, cleansing enemas. According to the indications, an operative benefit was provided by open and laparoscopic accesses.Results. The sensitivity of the x-ray method was 88%, but the sensitivity of the plain x-ray examination, supplemented with a barium enema (irrigoscopy), was 100%. The sensitivity of the ultrasound method was 57%, however, when supplemented with a Doppler study, the sensitivity increases to 72%. The sensitivity of CT was 100%. The sensitivity of colonoscopy among those studied is 96%. Operations performed in patients with volvulus of the sigmoid colon: endoscopic detorsion in 15 patients (64.3%), video-laparoscopic elimination of volvulus of the sigmoid colon in 3 (10.7%) patients. Midline laparotomy in 17 patients (60.7%). Among patients after endoscopic bowel detorsion, no complications were observed in the early period. After laparotomy and elimination of volvulus of the sigmoid colon, postoperative complications were observed in 3 (17.7%) patients. There were 3 deaths (10.7%).Conclusion. High mortality does not allow us to call the results of treatment satisfactory, and a small number of observations does not allow us to obtain statistically significant results, which requires further case recruitment and data analysis.

Keywords

• sigmoid volvulus
• colonic obstruction
• irrigoscopy (barium enema)
• colonoscopy
• laparoscopy
• intestinal detorsion