Elective Treatment of Large-Bowel Obstruction in Asymptomatic Sigmoid Volvulus
V. 171 N. 6 (2020), Case report
V. 171 N. 6 (2020)

Elective Treatment of Large-Bowel Obstruction in Asymptomatic Sigmoid Volvulus: doi: 10.7417/CT.2020.2258

Case report
Pubblicato 2020-11-02
M. Assenza
Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
F. Ciccarone1
Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
I. Iannone
Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
G. Bracchetti
Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
E. De Meis
Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
S. Santillo
Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
C. Ballanti Storace
Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
G. Mazzarella
Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
M.L. De Cicco
Radiology Department of Emergency Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Parole chiave

Sigmoid volvulus
asymptomatic volvulus
uncomplicated volvulus
large-bowel obstruction

Abstract

Background
Sigmoid volvulus is an uncommon cause of intestinal obstruction representing the 5% of all Western cases, associated with old age and a history of neurological and psychiatric condition. Generally, its diagnosis is established by clinical and radiologic findings.

It often represents an emergency and it is commonly associated with pain, vomit and abdominal tenderness.

Case presentation
We present a case of a 59 years old man, admitted to our emergency department, showing an abdominal X-Ray reporting a distention of large bowel,which was required due to presence of multiple diarrhea episodes during the previous 7 days. He had no significant past medical history and did not report constipation or subocclusive episode.

Conclusions
Volvulus should be considered in the differential diagnosis in adult and healthy patients with bowel obstructions. Surgery is, in all cases, the radical and definitive treatment since there is a higher mortality in case of recurrent volvulus. Despite the massive bowel distention, our choice was the elective open surgery. Primary anastomosis is feasible and safe and did not lead to any complications. In case of unsuccessful colonic decompression, evidence to support or refute the safety and effectiveness of laparoscopic surgical resection for treatment of patients with sigmoid volvulus disease is not yet proven.

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