Tuesday, 1 January 2013
sigmoid volvulus
About 38yr old female had gross fecal impection due to huge feacolith of a cricket ball size at rectosigmoid region.she had acute obstruction with sigmoid volvulus. feacolith was dismpected ,menual per rectal removal was done,considering young age and negative history of chronic constipation, simple plication of sigmoid colon was done( as per literature colon resection is recommanded). patient was fine and post op uneventful, had followup of about 1 year with satisfactory result. in 2 similar cases we had put the sigmoid colon in the subcutaneous space also by inguinal incision, all the pt who were co-morbid and high risk for resection,they have also behaved well but constipation is always an issue in patients without resection.few cases were done with resection and results were better(unfortunately no pictures available). two patient had leak from resection site, and converted in to colostomy.nowadays due to good bulk forming agents ,incidence of sigmoid volvulus are decreasing.(this post is not in favour of plication against resection)
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