A 67-year-old gentleman presented to the A&E with acute abdominal pain with distention. He has not opened his bowel for five days nor passed any flatus. He reported 3 episodes of vomiting. PMH of diverticulosis and long-standing constipation on laxatives & Right THR. O/E, his abdomen is markedly distended & there is diffuse tenderness on palpation. A CT Abdomen & Pelvis has been requested by the surgical Reg on-call which showed dilated bowel loops & a lesion at the transition point. The surgery team is consulted and he is prepped for surgical intervention.
Sigmoid Volvulus
- Large bowel obstruction from other causes
- Caecal volvulus
- Colonic pseudo-obstruction
- Chronic constipation and/or laxative abuse
- Fiber-rich diet
- Chagas disease
PH : 7.3
PaO2 : 12.3 Kpa
PaCo2 : 3.9 Kpa
BE : -6
HCO3 : 18
Lactate : 4
Partially compensated metabolic acidosis; due to lactic acidosis by ischæmic bowel or sepsis.
- Labs : FBC, CRP, U&Es, ABG
- Imaging
- Abdominal radiographs
-
Computed tomography (CT) of abdomen and pelvis with contrast
- Managing this patient according to Care of The Critically Ill Surgical Patient Protocol; ABCDE Approach
- Nil by mouth, NGT insertion, IVF, IV Antibiotics, correct any electrolyte imbalance
- Without ischemia or perforation Endoscopic detorsion (via flatus tube insertion under rigid/flexible sigmoidoscopy) successfully treats around 85% of patients
- With ischemia or perforation exploratory laparotomy and Hartmann’s procedure if sigmoid colon is the affected part.