What is Sigmoid Volvulus?
Sigmoid volvulus is a serious medical condition in which the sigmoid colon (the S-shaped section of the large intestine) twists upon itself, leading to an obstruction. This twisting can block the passage of stool and gas, cause blood flow restriction, and, if untreated, result in tissue death (necrosis) and perforation. It is a medical emergency that requires prompt diagnosis and intervention.
Causes and Risk Factors
While the exact cause of sigmoid volvulus varies from person to person, several risk factors increase the likelihood of developing this condition:
- Chronic Constipation – Long-term constipation can lead to colon elongation and an increased risk of twisting.
- Congenital Anomalies – Some individuals are born with an unusually long or mobile sigmoid colon, making them more prone to volvulus.
- Dietary Habits – A diet low in fiber and high in processed foods can contribute to sluggish bowel movements and increased risk.
- Neurogenic Disorders – Conditions such as Parkinson’s disease, multiple sclerosis, and dementia can slow bowel motility, predisposing individuals to volvulus.
- Previous Abdominal Surgery – Surgical adhesions or scar tissue can contribute to an abnormal positioning of the colon.
- Elderly Population – Older adults, particularly those in nursing homes or long-term care facilities, are at higher risk due to reduced mobility and altered bowel habits.
Signs and Symptoms
Sigmoid volvulus can develop gradually or suddenly. Symptoms include:
- Severe Abdominal Pain – Often crampy or colicky in nature and located in the lower abdomen.
- Bloating and Distension – The abdomen may appear swollen and firm due to trapped gas.
- Constipation or Lack of Bowel Movements – The twisting of the bowel prevents normal stool passage.
- Nausea and Vomiting – May occur as the blockage worsens.
- Tympanitic Abdomen (Drum-like Sound on Percussion) – A hallmark clinical sign of volvulus.
- Shock Symptoms (in Severe Cases) – If the blood supply is cut off, a patient may develop rapid heart rate, low blood pressure, and fever, indicating a life-threatening emergency.
Diagnosis of Sigmoid Volvulus
A prompt and accurate diagnosis is critical to prevent complications. The following diagnostic tools are commonly used:
- Physical Examination – The doctor will assess the abdomen for tenderness and bloating.
- X-ray (Abdominal Plain Film) – May show a classic “coffee bean” sign, indicating the twisted loop of the sigmoid colon.
- CT Scan – Provides a detailed image to confirm obstruction and evaluate for complications such as bowel perforation.
- Barium Enema – In some cases, contrast studies help outline the abnormal bowel anatomy.
Treatment Options for Sigmoid Volvulus
The treatment for sigmoid volvulus depends on the severity of the condition and whether complications like bowel ischemia (lack of blood flow) are present.
1. Non-Surgical Treatment (Endoscopic Detorsion)
- Flexible Sigmoidoscopy – In stable patients without signs of necrosis or perforation, a doctor may use a flexible tube with a camera to untwist the colon.
- Decompression – A rectal tube may be placed to relieve pressure and prevent recurrence.
- Close Monitoring – Patients may be observed for recurrence, and dietary/lifestyle modifications are recommended.
2. Surgical Treatment (For Severe Cases or Recurrence)
- Sigmoid Colectomy (Bowel Resection) – If the volvulus recurs or the bowel is damaged, the affected portion is surgically removed.
- Primary Anastomosis – The healthy ends of the colon are reconnected after resection.
- Colostomy (In Some Cases) – If there is severe inflammation or infection, a temporary or permanent colostomy (an external opening for stool elimination) may be required.
Recovery and Prevention
After successful treatment, patients should take steps to prevent recurrence:
- Increase Fiber Intake – A diet rich in fruits, vegetables, and whole grains can promote regular bowel movements.
- Stay Hydrated – Drinking plenty of fluids helps keep stool soft and easier to pass.
- Exercise Regularly – Physical activity encourages bowel motility.
- Manage Underlying Conditions – Treating chronic constipation and neurological disorders can reduce the risk.
- Regular Follow-Up – Patients with a history of volvulus should have periodic check-ups to monitor colon health.
Frequently Asked Questions (FAQ) About Sigmoid Volvulus
Q1: Is sigmoid volvulus a life-threatening condition?
Yes, if left untreated, it can lead to bowel obstruction, tissue death, and perforation, which are life-threatening and require emergency surgery.
Q2: Who is most at risk for sigmoid volvulus?
Elderly individuals, those with chronic constipation, people with neurological disorders, and individuals with a history of abdominal surgery are at higher risk.
Q3: How quickly should I seek medical attention if I suspect sigmoid volvulus?
Immediately. If you experience severe abdominal pain, bloating, vomiting, and constipation, go to the emergency room or contact Park Avenue Colon and Rectal Surgery at (646) 822-0228.
Q4: Can sigmoid volvulus be treated without surgery?
Yes, in some cases, flexible sigmoidoscopy can untwist the bowel. However, if complications arise or if the condition recurs, surgery may be necessary.
Q5: What happens if volvulus goes untreated?
Untreated volvulus can lead to bowel necrosis (tissue death), sepsis, perforation, and severe infections, all of which can be fatal.
Q6: Will I need a colostomy after surgery?
Not always. Most patients undergo primary anastomosis, where the healthy bowel sections are reconnected. However, in severe cases with infection or damage, a temporary or permanent colostomy may be needed.
Q7: Can sigmoid volvulus recur?
Yes, recurrence is common, especially if underlying risk factors are not addressed. Surgical removal of the affected section significantly reduces the risk.
Q8: What can I do to prevent sigmoid volvulus?
- Eat a high-fiber diet
- Stay hydrated
- Exercise regularly
- Treat constipation promptly
- Follow medical advice on managing neurological conditions
Q9: Where can I get expert care for sigmoid volvulus in New York City?
At Park Avenue Colon and Rectal Surgery, we specialize in the diagnosis and treatment of colorectal conditions, including sigmoid volvulus. Our expert team offers both non-surgical and surgical options tailored to your needs.
📍 Address: 36 E 36th St, 1C, New York City, NY 10016
📞 Phone: (646) 822-0228
For expert consultation and advanced care, contact us today! 🚑💙