Sigmoid volvulus, a potentially life-threatening large bowel obstruction, is caused by torsion of the sigmoid colon around its mesenteric axis. It commonly occurs in elderly patients with predisposing factors such as chronic constipation, long sigmoid loop, and comorbidities that increase operative risk. Rapid diagnosis and timely surgical management are essential to prevent ischemic necrosis and perforation. A 67-year-old man with a history of hypertension and diabetes mellitus presented with intermittent colicky abdominal pain and distension for three days, accompanied by constipation and failure to pass flatus. There was no vomiting or fever. Clinical examination revealed a distended abdomen with diffuse tenderness but no guarding or rigidity. Investigations demonstrated leukocytosis, normal liver and renal profiles, and radiographic features of large bowel obstruction suggestive of sigmoid volvulus. The patient was optimized for surgery, and emergency exploratory laparotomy was performed. Intraoperatively, a twisted and dilated sigmoid colon with ascitic fluid was found. The procedure included detorsion, resection of the redundant sigmoid segment, primary anastomosis, proximal transverse colostomy, and peritoneal toilet. Postoperatively, the patient recovered uneventfully apart from mild respiratory distress. Progressive dietary advancement and colostomy function were satisfactory. After six weeks, colonoscopy and distal loop colonogram confirmed a healthy anastomosis, and colostomy closure was successfully performed. Follow-up at three months showed complete recovery and return to normal activities. This case emphasizes that early recognition and prompt surgical intervention in sigmoid volvulus, even in elderly and comorbid patients, can achieve excellent outcomes. A staged approach with proximal diversion during initial surgery minimizes anastomotic complications and ensures safe restoration of bowel continuity after recovery.
Wyke et al. (Sat,) studied this question.