Sigmoid volvulus is one of the acute abdomen that requires endoscopic intervention and/or surgery. High recurrence rates after detorsion require patients to be operated under elective conditions. A 32 year oldmental retarded male patient was operated for recurrent sigmoid volvulus. In this study, we aimed to present a giant recurrent sigmoid volvulus case accompanied by diaphragmatic hernia

Aslaner, Erhan

Badak, Bartu

Gambarov, Nahid

English

Publishing House of Ivano-Frankivsk National Medical University

Galician medical journal 2020Vol. 27, Issue 2, E202023DOI: 10.21802/gmj.2020.2.3Case ReportGiant Relapse Sigmoid Volvulus: Case ReportBartu Badak*, Erhan Aslaner, Nahid GambarovAbstractSigmoid volvulus is one of the acute abdomen that requires endoscopic intervention and/or surgery. Highrecurrence rates after detorsion require patients to be operated under elective conditions. A 32 year oldmentalretarded male patient was operated for recurrent sigmoid volvulus. In this study, we aimed to present a giantrecurrent sigmoid volvulus case accompanied by diaphragmatic hernia.Keywordsvolvulus; sigmoid; herniaDepartment of General Surgery, Eskiehir Osmangazi University, Eskisehir, Turkey*Corresponding author: drbartu@gmail.comCopyright ©Bartu Badak, Erhan Aslaner, Nahid Gambarov, 2020Introduction:Sigmoid colon is the most mobile part of the gas-trointestinal tract due to the mesentery length of thesigmoid colon. Intestinal volvulus (90%) is a morecommon evidence compared to other intestinal seg-ments as a result of its revolving around mesentericstructures. Different procedures have been definedto prevent recurrence after detorsion [1]. One ofthe most effective methods of these procedures issegmental bowel resection. In emergency condi-tions, anastomosis or Hartmann colostomy shouldbe decided after segmented resection according tothe current condition of the patient [2]. In our study,we aimed to present a 32-year-old patient who wasoperated due to a recurrent giant sigmoid volvulus.1. Case32 year old male and mental retarded patient ap-plied to the emergency service with the complaintof swelling and constipation in her abdomen for 5days. It was learned that the patient had a previoushospitalization due to sigmoid volvulus and a boweloperation due to ileus. Her physical examinationrevealed no audible left lung sounds, swelling inboth scrotums, excessive distention in the abdomen,and peritoneal irritation. Routine laboratory exami-nation showed that Wbc: 41.880/uL Hgb: 11.4 g/dlarterial blood gas parameters Lactate: 5.3 mmol/L.Verbal interpretation of intravenous (IV) contrastcomputed tomography was found to be compatiblewith sigmoid volvulus. Later, the patient was givenan informed consent from his family members anda laparotomy was decided.Diagnostic laparotomy was applied to the pa-tient. After exploration it was observed that thesigmoid colon extended from the left thoracic cav-ity to the pelvis (Fig. 1). It was seen that the sigmoidcolon was perforated in 2 places and its wall wasnecrotic and its diameter reached approximately 20cm (Fig. 2). Sigmoid colon was taken out of theabdomen and segmented bowel resection and Hart-mann procedure were performed. Small intestinesegments were found to be herniated from the leftingunal canal and the small intestines were returnedto the abdomen. Left ingunal hernia was repairedfrom a separate skin incision. During the operation,the patient’s blood pressure was 50/40 mmHg, soGiant Relapse Sigmoid Volvulus: Case Report — 2/4Figure 1. Intraoperative diaphragmatic hernia.Figure 2. Dilated and perforated sigmoid colon.the right scrotum could not be intervened and theoperation was terminated. The patient was takento the surgical intensive care unit in the postoper-ative period, and appropriate antibiotherapy wasstarted. The patient, who was extubated on thepostoperative 6th day, was taken to the surgical ser-vice. Afterwards, the patient, whose tolerance oforal intake progressed, was discharged on the 15thpostoperative day.2. Discussion and ConclusionColon volvulus is the third leading cause of colonobstruction in the world following colorectal cancerand complicated sigmoid diverticulitis [2].It is more common in men and the elderly [3, 4].In the etiology, factors such as long sigmoid colonand narrow-bottomed sigmoid mesocolon existence,diet, colon motility disorder, Chagas disease andscleroderma play a role [5, 6].Spontaneous detortion of the sigmoid volvulusis not common [7]. Patients generally tend to havehypovolemic and endotoxic shock due to closed-loop obstruction and gangrene [8, 9].In sigmoid volvulus cases, it is reported thatdetortion with endoscopic intervention is successfulin 76-89% of cases, and 50% of caecal volvuluscases develop 21-57% again [10]. Therefore, sur-gical intervention in elective conditions is recom-mended for all patients who have successful endo-scopic detortion. If endoscopic detorsion fails orif there are signs of peritonitis, surgery should beperformed without waiting. If there is gangrene orperitonitis, Hartmann procedure is applied [11]. Inour patient, endoscopic detortion was not consid-ered due to both relapse of the volvulus and acuteabdominal signs in the patient. End colostomy wasperformed with sigmoid resection.In this case, we think that sigmoid volvuluscaused the accompanying mental retardation, chronicconstipation, diaphragmatic hernia and previous ab-dominal operation to reach much larger than ex-pected.Abdominal contamination due to perforation ex-plains the preoperative septic table of the patient.Because of diaphragmatic hernia, it was thoughtthat the left lung was collapsed in the chronic pro-cess. The chest radiograph of the patient, takenat our institution about 6 years ago, showed thatthere was no pathology in the left lung (Fig. 3). Inhis application, it was seen that the left lung wascompletely collapsed (Fig.4). It was decided toterminate the operation to evaluate the right scro-tal swelling in the elective conditions due to thepatient’s septic table and prolonged anesthesia.In our patient, colonic anastomosis was notGiant Relapse Sigmoid Volvulus: Case Report — 3/4Figure 3. 2013 X-ray image.Figure 4. 2019 X-ray image.found suitable because of the findings of peritonealirritation and the diameter of the sigmoid colonreached very large dimensions.Bilateral scrotal swelling diaphragmatic herniacoexistence of giant recurrent sigmod volvulus isour case report.Surgical treatment methods applied in emer-gency conditions result in high morbidity and mor-tality rates (12-53%) due to the advanced age ofpatients, presence of comorbid factors, general con-dition disorder, and inability to perform preopera-tive bowel cleansing [12]. When surgical treatmentperformed under emergency conditions and surgi-cal methods performed under elective conditionsafter colonoscopic decompression are compared,it is seen that there is a significant difference inmorbidity and mortality [12, 13].The most effective method of preventing recur-rence in the treatment of sigmoid volvulus is colonresection to be applied to the volvulus segment. Thenecessity of primary anastomosis or Hartmann’sprocedure, which can be applied after resection,may vary depending on the general condition of thepatients and the presence of perforation.Elective operation options should be evaluatedfor each patient in detortioned volvulus, and theprobability of mortality and morbidity in recurrentvolvulus cases should not be forgotten.Informed ConsentWritten informed consent was obtained from thepatient who participated in this case.Conflict of InterestThe authors stated no conflict of interest.Financial DisclosureThe authors declared no financial support.References[1] Kuzu MA, Aslar AK, Soran A, Polat A, Topçu O, Hengirmen S. Akut sigmoid volvulus için acil rezeksiyon: ardışık 106 vakanın sonuçları. Dis Colon Rectum 2002; 45: 1.085 -90. DOI: https://doi.org/10.1007/s10350-004-6364-0 [PMid:12195194][2] GH Ballantyne, MD Brandner. Koloninsidansı ve mortalitesi VolvulusuAnn. Surg., 202 (1985) , 83 - 92DOI: https://doi.org/10.1097/00000658-198507000-00014[PMid:4015215 PMCid:PMC1250842][3] Lal SK, Morgenstern R, Vinjirayer EP, etal. Sigmoid volvulus an update. Gastroin-test Endosc Clin N Am 2006; 16: 175-187. DOI: https://doi.org/10.1016/j.giec.2006.01.010 [PMid:16546032]Giant Relapse Sigmoid Volvulus: Case Report — 4/4[4] Raveenthiran V, Madiba TE, AtamanalpSS, et al. Volvulus of the sigmoidcolon. Colorectal Dis 2010; 12: 1-17. DOI: https://doi.org/10.1111/j.1463-1318.2010.02262.x[PMid:20236153][5] Gibney, EJ. Volvulus of the sigmoid colon.Surg Gynecol Obstet 1991; 173: 243-255.[PMID: 1925892][6] Ballantyne GH, Brander MD, Beart RWJ,et al. Volvulus of the colon: incidenceand mortality. Ann Surg 1985; 202:83-92. DOI: https://doi.org/10.1097/00000658-198507000-00014[PMid:4015215 PMCid:PMC1250842][7] Arnold GJ, Nance FC. Sigmoid kolonvolvulus. Ann Surg 1973; 177: 527- 31. DOI: https://doi.org/10.1097/00000658-197305000-00004[PMid:4704037 PMCid:PMC1355585][8] Atamanalp SS, Ö ren D, Başoğlu M,Yildirgan MI Balık AA, et al. Ileosig-moidal dü ğü mleme: 63 hastada sonuç.Dis Colon Rectum 2004; 47: 906 -910. DOI: https://doi.org/10.1007/s10350-004-0528-9 [PMid:15129310][9] Ö ren D, Atamanalp SS, Aydınlı B, YildirganMI Başoğlu M, et al. Sigmoid kolon volvu-lusunun yö netimi ve primer rezeksiyonungü venliği iç in bir algoritma: 827 vaka iledeneyim. Dis Colon Rectum 2007; 50: 489 -497. DOI: https://doi.org/10.1007/s10350-006-0821-x [PMid:17205203][10] Grossmann EM, Longo WE, Stratton MD,Virgo KS, Johnson FE. Sigmoid volvulusin Department of Veterans Affairs MedicalCenters. Dis Colon Rectum 2000; 43: 414-418. DOI: https://doi.org/10.1007/BF02258311 [PMid:10733126][11] Brothers TE, Strodel WE, Eckhauser FE. En-doskopy in colonic volvulus. Ann Surg 1987;206: 1-4. DOI: https://doi.org/10.1097/00000658-198707000-00001[PMid:3606228 PMCid:PMC1492925][12] Neil DA, Reasbeck PG, Reasbeck JC, EffeneyDJ. Caecal volvulus: Ten year experience in anAustralian teaching hospital. Ann R Coll SurgEngl 1987; 69: 283-285.[13] Bak MP, Boley SC. Sigmoid volvulus in el-derly patients. Am J Surg 1986; 151: 71-75. DOI: https://doi.org/10.1016/0002-9610(86)90014-0Received: 2020-02-24Revised: 2020-04-13Accepted: 2020-04-14

Giant Relapse Sigmoid Volvulus: Case Report

https://ifnmujournal.com/gmj/article/download/E202023/975

Giant Relapse Sigmoid Volvulus: Case Report

Abstract

Similar works

Full text

Available Versions

Publishing House of Ivano-Frankivsk National Medical University