Sigmoid Volvulus: Understanding Its Nature, Prevalence, and Risk Factors
Introduction
The condition known as sigmoid volvulus has a rich and challenging history in the medical field. Originating from Latin roots, the term ‘volvulus‘ describes a ‘rolling’ or ‘twisting’ – aptly depicting the condition’s impact on the sigmoid colon. Sigmoid volvulus has been documented in medical literature for centuries, yet it remains a complex and potentially dangerous condition. It stands as a significant cause of bowel obstruction, especially in elderly populations, necessitating prompt and accurate diagnosis and treatment. This article aims to provide a comprehensive understanding of sigmoid volvulus, from its definition and description to its prevalence and risk factors, demystifying the condition for patients seeking information.
Definition
Sigmoid volvulus is a gastrointestinal condition characterized by the twisting of the sigmoid colon around its base, causing intestinal obstruction.
Description of Sigmoid Volvulus
Sigmoid volvulus is a condition where the sigmoid colon, located in the lower part of the large intestine, twists upon itself. This creates a loop, resulting in an obstruction that blocks the passage of material through the digestive tract. The progression of sigmoid volvulus can range from mild discomfort to a medical emergency, depending on the severity of the twist and how long it remains untreated. If the blood supply to the area is compromised, this can lead to necrosis, or death, of the affected bowel tissue – a serious complication requiring immediate medical attention.
As per the latest statistical data, sigmoid volvulus is not a common condition. It represents about 5% of all cases of bowel obstruction in North America but is more prevalent in certain regions worldwide, such as Africa and Asia. Moreover, the condition primarily affects older adults, with a peak incidence in the seventh and eighth decades of life. While it can occur at any age, including in infants, such cases are comparatively rare.
Risk Factors for Developing Sigmoid Volvulus
Lifestyle Risk Factors
A sedentary lifestyle may be associated with an increased risk of developing sigmoid volvulus. Constipation, often resulting from a low-fiber diet and lack of physical activity, can lead to increased pressure and subsequent twisting in the colon. Furthermore, chronic use of certain medications, like opioids, can slow bowel movements, potentially contributing to the condition.
Medical Risk Factors
Certain underlying medical conditions can increase the likelihood of sigmoid volvulus. Chronic constipation and conditions causing nerve damage to the colon, such as Parkinson’s disease or diabetes, can predispose individuals to this condition. Moreover, previous abdominal surgeries that alter the normal anatomy or adhesions from previous infections can also increase the risk.
Genetic and Age-Related Risk Factors
Age significantly influences the prevalence of sigmoid volvulus, with older adults at a higher risk. Genetic factors may also play a role, but research in this area is still ongoing. Some studies suggest a possible association with specific genetic conditions, such as Hirschsprung’s disease, which affects nerve cells in the colon. Additionally, male gender appears to be a risk factor, with men being more likely to develop the condition than women.
Clinical Manifestations
Abdominal pain
Abdominal pain is experienced by nearly 85-90% of individuals with sigmoid volvulus. It often starts as a crampy or colicky discomfort, usually in the lower left quadrant of the abdomen, where the sigmoid colon is located. As the twist progresses, it obstructs the passage of gas and feces, causing increasing pressure and thus escalating pain. It might become constant and severe if the blood supply to the colon is compromised, necessitating immediate medical intervention.
Abdominal distension
Approximately 80% of patients with sigmoid volvulus report abdominal distension or bloating. This symptom occurs due to the accumulation of gas and feces upstream of the obstruction. The bloating typically increases as the condition progresses and might be visible to the naked eye, making the abdomen appear swollen and tense.
Nausea and vomiting
Experienced by around 50-70% of individuals with sigmoid volvulus, nausea and vomiting are common symptoms. They result from the bowel obstruction, which prevents normal digestion and passage of food contents. If the obstruction persists, the contents may back up, leading to vomiting. As the condition advances, the vomit may contain fecal material.
Constipation
Constipation, affecting approximately 50% of sigmoid volvulus patients, is a direct result of the bowel obstruction. The twisting of the colon prevents feces from passing through the digestive tract, leading to constipation. This symptom is generally more common in the later stages of the disease.
Inability to pass gas or stool
Around 70% of patients with sigmoid volvulus may experience an inability to pass gas or stool. This is a cardinal sign of bowel obstruction caused by the twisting colon. When severe, this symptom might be accompanied by a sense of fullness and discomfort.
Tenderness in the abdomen
Tenderness in the abdomen is felt by about 60-70% of sigmoid volvulus patients. As the obstruction causes distension and pressure builds up, the abdomen can become sensitive to touch. This symptom typically intensifies as the condition progresses, and it might indicate that urgent medical attention is needed.
Rapid heart rate
Around 40-50% of patients might experience a rapid heart rate, medically known as tachycardia. This is usually a response to pain and stress caused by the volvulus. If the blood supply to the colon is compromised, the body’s compensatory mechanisms may cause an increase in heart rate to maintain adequate blood flow to vital organs.
Diagnostic Evaluation
Diagnosis of sigmoid volvulus is typically made based on the patient’s symptoms, physical examination findings, and various diagnostic tests. These tests help visualize the twisted colon and determine the severity of the condition. Let’s look into some common diagnostic evaluations used in detecting sigmoid volvulus.
Abdominal X-ray
An abdominal X-ray is a simple, quick, and non-invasive imaging test that uses a small amount of radiation to capture images of the abdomen. During the test, the patient lies on an X-ray table, and a machine directs X-ray beams at the abdomen. This test can often show signs of bowel obstruction, such as dilated loops of intestine and air-fluid levels. In sigmoid volvulus, a characteristic finding is the “coffee bean sign,” where the
twisted sigmoid colon appears like a large, bent coffee bean.
A positive X-ray result showing signs of sigmoid volvulus necessitates further confirmatory testing and immediate treatment. However, if the X-ray result is negative but symptoms persist, further tests, such as a CT scan or sigmoidoscopy, are needed to ascertain the cause of the symptoms.
Contrast enema
A contrast enema, also known as a barium enema, is a type of X-ray test. It involves introducing a contrast agent (usually a type of barium) into the rectum using a thin tube. This contrast agent helps highlight the colon and rectum on X-rays. The test can show a “bird’s beak” appearance in sigmoid volvulus, indicating the point of twisting. It’s important for diagnosing sigmoid volvulus and may also be therapeutic – it can sometimes help untwist the volvulus.
If a contrast enema shows the characteristic signs of sigmoid volvulus, immediate medical treatment is warranted. If it doesn’t show signs of sigmoid volvulus but symptoms continue, further evaluation with other tests may be necessary.
Computed tomography (CT) scan
A CT scan is a type of imaging test that uses X-rays and a computer to create detailed images of the body. For this test, the patient lies on a table that slides into a large, doughnut-shaped machine. It provides more detailed images than an X-ray and can show the precise location and extent of the volvulus. A whirlpool sign, where the twisted mesentery and vessels form a whirlpool-like image, is often seen in cases of sigmoid volvulus.
Positive CT scan results indicating sigmoid volvulus require prompt medical treatment. If results are negative but the patient still experiences symptoms, further testing is necessary, possibly including a sigmoidoscopy.
Sigmoidoscopy
Sigmoidoscopy is a procedure that allows the doctor to examine the lower part of the colon using a flexible tube with a light and camera at the end, known as a sigmoidoscope. This procedure can directly visualize the twist in the colon, confirm the diagnosis, and occasionally decompress the volvulus.
If the sigmoidoscopy results suggest sigmoid volvulus, immediate treatment is necessary. However, if no signs of sigmoid volvulus are observed but the patient continues to experience symptoms, further investigations may be required.
Complete blood count (CBC)
A complete blood count is a common blood test that measures different components of the blood, including red blood cells, white blood cells, and platelets. It can help detect infections, inflammation, and other medical conditions. In sigmoid volvulus, a CBC may show signs of infection or inflammation, such as increased white blood cells, if the blood supply to the colon is compromised and tissue damage has occurred.
If the CBC shows abnormalities suggestive of sigmoid volvulus, further diagnostic testing and prompt treatment are necessary. If the CBC is normal but symptoms persist, additional diagnostic evaluations may be recommended.
If all tests come back negative but symptoms persist, it’s essential not to ignore your symptoms. You should follow up with your healthcare provider to discuss the next steps. This could include further testing, referral to a specialist, or observation over time. Remember, it’s crucial to keep communicating with your healthcare provider to ensure your concerns are addressed.
Health Conditions with Similar Symptoms to Sigmoid volvulus
Colon Cancer
Colon cancer, often referred to as colorectal cancer, is a type of cancer that begins in the large intestine or the rectum. It usually starts with small, benign clumps of cells called polyps that can over time develop into cancers.
In distinguishing colon cancer from sigmoid volvulus, it’s important to consider the patient’s age, risk factors, and symptom duration. Colon cancer generally presents with symptoms that develop slowly over months to years, such as changes in bowel habits, blood in the stool, and unexplained weight loss. These symptoms are not typical for sigmoid volvulus, which usually presents with sudden onset abdominal pain and obstruction. Colonoscopy and biopsy are used to confirm a diagnosis of colon cancer.
Diverticulitis
Diverticulitis is a condition where small pouches, or diverticula, in the colon become inflamed or infected. This can cause severe abdominal pain, often on the left side, fever, and changes in bowel movements.
While diverticulitis shares symptoms such as pain, distension, and changes in bowel movements with sigmoid volvulus, it also often presents with fever, which is not commonly seen in sigmoid volvulus. A CT scan showing inflamed or infected diverticula can help differentiate diverticulitis from sigmoid volvulus.
Intestinal Obstruction
An intestinal obstruction is a blockage that prevents food or liquid from passing through either the small intestine or the large intestine (colon). This condition can result from a variety of causes, including hernias, tumors, or scar tissue from surgery.
Intestinal obstruction can present similarly to sigmoid volvulus, with symptoms like abdominal pain, vomiting, and inability to pass gas or stool. However, the location and nature of the pain can vary based on the site of obstruction. Imaging studies, including X-rays and CT scans, can help distinguish between these two conditions.
Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome is a common disorder that affects the large intestine. It presents with symptoms like cramping, abdominal pain, bloating, and changes in bowel habits.
Although IBS shares some symptoms like abdominal pain and bloating with sigmoid volvulus, its symptoms are usually chronic and come and go over time. Sigmoid volvulus, on the other hand, usually presents with acute, severe symptoms. Medical history, symptom review, and sometimes diagnostic tests can help differentiate between IBS and sigmoid volvulus.
Appendicitis
Appendicitis is an inflammation of the appendix, a small pouch attached to the large intestine. Symptoms include pain in the lower right abdomen, loss of appetite, nausea, and vomiting.
Although appendicitis can present with abdominal pain and nausea like sigmoid volvulus, the pain is typically located in the right lower abdomen. An ultrasound or a CT scan showing an inflamed appendix can help differentiate appendicitis from sigmoid volvulus.
Inflammatory Bowel Disease (IBD)
Inflammatory bowel disease refers to two conditions, Crohn’s disease and ulcerative colitis, that involve chronic inflammation of the digestive tract. Symptoms often include diarrhea, abdominal pain, weight loss, and fatigue.
While IBD and sigmoid volvulus can both cause abdominal pain and changes in bowel habits, IBD also commonly presents with bloody diarrhea and
weight loss, which are not typical symptoms of sigmoid volvulus. Colonoscopy with biopsy is often used to diagnose IBD.
Gastroenteritis
Gastroenteritis, often called “stomach flu,” is an inflammation of the lining of the intestines caused by a virus, bacteria, or parasites. Common symptoms include diarrhea, abdominal cramps, nausea, and vomiting.
While gastroenteritis can present with nausea, vomiting, and abdominal discomfort like sigmoid volvulus, it is often accompanied by diarrhea and sometimes fever, which are not typical symptoms of sigmoid volvulus. Additionally, gastroenteritis is usually of short duration and often linked to a recent event such as eating contaminated food.
Treatment Options
Medications
Antibiotics
Antibiotics are drugs used to treat bacterial infections. In the context of sigmoid volvulus, they are often used after a procedure to prevent infection.
Antibiotics are typically given if there is a concern for infection, such as after a procedure or if there is evidence of tissue damage or perforation.
With proper use, patients can expect to prevent or treat any bacterial infection, reducing the risk of complications.
Analgesics for pain management
Analgesics, or pain relievers, are medications used to reduce or eliminate pain. These can include drugs like acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), or opioids.
Analgesics are used to manage abdominal pain associated with sigmoid volvulus. The choice of analgesic often depends on the severity of the pain.
Proper use of analgesics can significantly alleviate pain, improving the patient’s comfort.
Antiemetics for nausea and vomiting
Antiemetics are drugs used to prevent or relieve nausea and vomiting. They work by blocking the signals to the vomiting center in the brain.
Antiemetics are used when nausea and vomiting are significant symptoms and are affecting the patient’s ability to eat or drink.
Patients can expect a decrease in nausea and vomiting with the use of these medications.
Procedures
Endoscopic detorsion
Endoscopic detorsion is a procedure where a long, flexible tube called an endoscope is used to untwist the twisted sigmoid colon.
This is typically the initial treatment for sigmoid volvulus, especially in patients who are not good surgical candidates. The procedure is performed under sedation.
After successful detorsion, patients usually experience immediate relief from their symptoms.
Sigmoid colon resection
Sigmoid colon resection is a surgical procedure to remove the affected part of the colon and then reconnect the remaining parts.
This procedure is usually performed if the volvulus recurs after an initial detorsion, or if the colon is damaged due to lack of blood supply.
After surgery, patients can expect resolution of their symptoms, but they will require a recovery period and follow-up care.
Sigmoidopexy
Sigmoidopexy is a procedure to anchor the sigmoid colon to the abdominal wall to prevent it from twisting in the future.
This procedure is typically performed after detorsion in patients who are poor surgical candidates for resection.
While sigmoidopexy can
prevent future episodes of volvulus, it does not address underlying problems with the colon that may lead to other issues.
Decompression using a rectal tube or colonoscope
Decompression is a procedure to relieve the pressure in the colon caused by the buildup of gas and fluid. It can be done using a rectal tube or during an endoscopy.
This procedure is typically performed urgently in the setting of acute sigmoid volvulus to provide immediate symptom relief.
Following decompression, patients usually experience immediate relief from their symptoms.
Bowel resection with anastomosis
Bowel resection with anastomosis is a surgical procedure where a portion of the bowel is removed and the remaining ends are connected together.
This procedure is typically performed in cases where there is significant damage to the bowel or if there is a high risk of recurrence.
Patients can expect resolution of their symptoms after recovery from surgery, but follow-up care is necessary.
Hartmann’s procedure
Hartmann’s procedure is a surgery to remove a part of the colon and then create a stoma, which is an opening on the abdomen for waste to pass into a bag.
This procedure is typically reserved for severe or complicated cases where the patient’s health is too unstable for a bowel resection with anastomosis.
After a Hartmann’s procedure, patients can expect relief from symptoms. However, they will need to adjust to living with a stoma, which will be supported by a stoma nurse or healthcare team.
Improving Sigmoid volvulus and Seeking Medical Help
Living with sigmoid volvulus requires an active approach to manage symptoms and prevent recurrence. Here are some home remedies that can help:
- Eating a high-fiber diet: Consuming plenty of fruits, vegetables, whole grains, and legumes can promote regular bowel movements and reduce the risk of constipation, which can contribute to sigmoid volvulus.
- Drinking plenty of fluids: Adequate hydration helps soften stools, making them easier to pass and reducing the strain on the bowel.
- Regular exercise: Physical activity stimulates normal contractions of the intestines, helping to prevent constipation and associated complications.
- Managing stress: Stress can exacerbate gastrointestinal problems. Mind-body practices like yoga, meditation, or deep breathing exercises may help manage stress levels.
- Avoiding constipation: Over-the-counter fiber supplements or stool softeners may be useful if dietary changes are not enough to prevent constipation.
- Seeking prompt medical attention: If you experience symptoms of sigmoid volvulus, such as abdominal pain, bloating, constipation, or inability to pass gas, seek medical attention immediately. Early intervention is key to preventing complications and improving outcomes.
Prevention and Management of Sigmoid volvulus: When to Seek Medical Help
Even with these home remedies, it’s crucial to maintain regular contact with your healthcare provider to monitor your condition. In the era of digital health, telemedicine offers a convenient way to do so. This means you can have virtual consultations from the comfort of your home, saving you travel time and reducing exposure to infectious diseases in healthcare settings.
Living with Sigmoid volvulus: Tips for Better Quality of Life
Living with sigmoid volvulus can be challenging, but it’s essential to remain proactive about your health. Alongside the tips mentioned above, maintain an open dialogue with your healthcare provider. Discuss any new symptoms promptly and fully participate in your treatment plan. Remember, your mental health is equally important, so consider counseling or support groups if you’re feeling overwhelmed.
Conclusion
Sigmoid volvulus is a serious condition characterized by a twist in the sigmoid colon, leading to bowel obstruction. Recognizing the symptoms and seeking prompt medical attention can significantly improve outcomes. Embrace a high-fiber diet, regular exercise, stress management, and adequate hydration as lifestyle modifications that can aid in managing this condition.
The importance of early diagnosis and treatment cannot be overstated. In our primary care practice, we’re committed to providing prompt, patient-centered care, accessible right from your home via telemedicine. Together, we can manage sigmoid volvulus effectively, ensuring you maintain the highest possible quality of life.
Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.