Sigmoid Colonic Volvulus

A 79-year-old male nursing home resident with Parkinson's disease was brought to the emergency department after 3 days of severe constipation and inability to pass flatus. Examination showed generalized abdominal distention with tympany. Results of rectal examination were normal.

An abdominal film showed a large, gas-filled sigmoid loop and distended colon (A). A meglumine enema demonstrated the site of obstruction in the distal colon with a typical shut-off sign (the bird-beak deformity, B), consistent with sigmoid volvulus. Decompression was achieved with use of the flexible sigmoidoscope. Following bowel preparation, the patient underwent sigmoid colon resection.

Sigmoid colon volvulus occurs mainly in the elderly and in both sexes. Almost all such patients have a long history of disordered bowel habits, and many are nursing home residents with such disorders as parkinsonism, Alzheimer's disease, paralysis, psychiatric disorders, or senility. The usual presentation is generalized abdominal distention with obstipation; severe pain, tenderness, and fever suggest strangulation.

As initial treatment, writes Dr Virendra A. Parikh of Fort Wayne, Ind, attempt nonoperative sigmoidoscopic reduction. If this is successful, delayed sigmoidal resection is recommended. If sigmoidoscopic decompression is unsuccessful, or if there is a strangulated bowel, emergency resection and colostomy are necessary.