Sigmoid colon volvulus

• Pain in abdomen – initially left-sided, eventually all over • Absolute constipation • Enormous distension of abdomen • Late vomiting and eventually dehydration • Features of peritonitis • Hiccup and retching may occur • Tyre-like feel of the abdomen is diagnostic ==Cause==

The condition is more common in males and with old age. It is also common in people with chronic constipation and laxative abuse. It is common in: • Ogilvie syndrome • Individuals with learning difficulties • Chagas disease • Hypothyroidism • Anticholinergic drugs • Multiple sclerosis • Scleroderma • Parkinson's disease In sigmoid, volvulus rotation is always anticlockwise. It requires one and a half rotation to cause vascular obstruction and gangrene which eventually leads to perforation either at the root or at the summit of the sigmoid loop. == Diagnosis ==

• Plain X-ray (diagnostic in 70–80%): coffee bean sign is seen • Contrast enema: bird beak sign • CT scan: shows characteristic whirl pattern • Blood: haematocrit, renal functions, serum electrolytes == Treatment ==

• RT aspiration • IV fluids • Catheterisation • Antibiotics • By flatus tube or sigmoidoscope, derotation is done • If derotation does not occur, then laparotomy through midline incision should be done. It is derotated manually. If viable, it can be fixed to lateral wall of abdomen or pelvis • If sigmoid colon is gangrenous, then Hartmann's operation or Paul Mikulicz operation is done == References ==