Sigmoid volvulus: Causes, Symptoms, Treatment and Cost

Sigmoid volvulus is a type of bowel disorder in which the sigmoid colon (the last section of the large intestine) becomes twisted and forms a tight coil. This condition can lead to an obstruction in the bowel, which causes severe abdominal pain, vomiting, and sometimes even death when untreated.

There are two types of sigmoid volvulus:- primary and secondary sigmoid volvulus.

• Primary Sigmoid Volvulus: Primary sigmoid volvulus happens when the twisting occurs spontaneously due to a weakening in the connecting tissue that holds together the digestive organ, called mesentery. This type of sigmoid volvulus occurs in individuals whose geography or genetic predisposition may make them vulnerable to this disorder.
• Secondary Sigmoid Volvulus: Secondary sigmoid volvulus occurs as a result of underlying conditions such as hernias, adhesions, abnormalities in the mesentery or enlarged lumps can put pressure on the connecting tissue, making it weaker than usual. In addition, several medical disorders such as Parkinson’s disease can cause constipation—an important factor for primary and secondary diseases alike.

• Sigmoid volvulus is most commonly caused by a combination of factors such as poor dietary habits, consuming a large meal, physical exertion, and constipation.
• Other causes include genetic predisposition like familial polyposis, neurological conditions leading to abnormal muscle contractions of the colon wall, and anatomical abnormalities that can cause twisting of the bowel.

• Abdominal pain, discomfort, and bloating.
• Nausea and vomiting
• Diarrhoea or constipation, or alternating diarrhoea and constipation.
• Loss of appetite
• Unexplained weight loss
• Abdominal distention (swelling).
• Fever in some cases
• Rectal bleeding.

• Eat high-fibre foods, such as fruits, vegetables, and whole grains.
• Avoid fatty, fried, or processed foods.
• Practise good hydration by drinking plenty of non-alcoholic fluids.
• Use the bathroom regularly and avoid constipation triggers such as certain medications or dairy products.
• Exercise regularly to prevent constipation and bloating which can cause Sigmoid volvulus.

• Physical Examination:During a physical exam, a doctor will look for signs of abdominal pain, bloating or distension, tenderness, guarding or rigidity in the lower abdomen, nausea and/or vomiting.
• X-rays:An X-ray utilising barium enema may be used to detect if Sigmoid Volvulus is present. This type of X-ray will show changes typical of Sigmoid Volvulus such as abnormalities in colonic wall thickness and contour.
• Endoscopy:During endoscopy, a flexible scope (an endoscope) with a light and camera is inserted through the mouth or rectum into the colon while the patient is sedated. The scope allows the doctor to view inside the intestine, locate any twisted areas of bowel, and take images for further analysis.
• CT scan:A CT scan can help detect intestinal obstruction or twisted bowel segments.
• Colonoscopy:Colonoscopy is a procedure which involves a doctor threading an instrument called a colonoscope into the rectum and through the large intestine to view the lining of this area. This helps to diagnose and treat any issues that are present.

• The most common complication from a sigmoid volvulus is intestinal obstruction. This can lead to abdominal pain, nausea and vomiting, bloating and tenderness, constipation and even shock.
• Other possible complications include bleeding (due to erosion of blood vessels), perforation through the wall of the intestine, infection of the abdominal cavity (peritonitis), fecalomas (pockets/accumulations of compacted faecal material) and inflammation in neighbouring organs (such as appendix or bladder).
• In advanced cases, a sigmoid volvulus can also cause ischemia (reduced blood flow to the area) which can lead to gangrene or necrosis of the surrounding tissue.

• Ayurvedic treatment of sigmoid volvulus includes herbs such as 'Rasaunt' and 'Yashtimadhu'. They are taken orally with milk or warm water to reduce the abdominal pain and discomfort felt in this condition.
• Panchakarma therapies such as Abhyangam (oil massage), Sweden (warm oil massage) and Basti (medicated enema) are also recommended for its treatment.
• Herbal decoctions like Guduchi, Lakshadi guggulu, Mustadi Chungidi, Kutaja and Patoladi can be taken to provide relief from sigmoid volvulus symptoms.

• Significant decreases in the intake of all solid foods should be done till symptoms improve.
• Liquids like fresh fruit juices or vegetable soups should be consumed.
• Eating small and frequent meals is beneficial to reduce the episodes of bloating and abdominal cramps.
• Foods like oats, barley, banana, apple sauce and cooked vegetables can be taken at a gradual pace after two days of liquid diet consumption.
• Oat based breakfast cereal with warm milk could be taken as breakfast choice for slow reintroduction of food items after recovery from Sigmoid volvulus condition.

• Foods containing roughage and fibre, such as whole grain breads and cereals, fruits (especially the skins or membranes of apples and pears), legumes, vegetables, nuts, and seeds should be avoided in a sigmoid volvulus diet.
• High-fat foods can also contribute to constipation, so it is best to limit or avoid items high in fat such as burgers, sausages, fried foods and dairy products like cream cheese and ice cream.
• Processed snacks like chips and crackers should also be avoided as they can slow down digestion even further.
• Carbonated beverages can also cause gas buildup in the digestive tract and increase discomfort with a sigmoid volvulus diagnosis so are advised against.

• Manual Reduction:Intestinal obstruction caused by a sigmoid volvulus can be relieved with manual reduction, where a surgeon uses pressure to return the colon to its normal position.
• Resection and Colostomy:A segment of affected bowel may need to be removed, which would require an anastomosis (rejoining of healthy bowel) procedure or even a colostomy (if the recirculation of the bowel fails).
• Laparoscopic Surgical Techniques:Laparoscopic surgery, in which small incisions are made in the abdomen and surgical tools are inserted through them, have been found to be effective for sigmoid volvulus treatment.
• Open Surgical Technique:If laparoscopic surgery is not possible, then open surgery can be used as an option for treating sigmoid volvulus where small cuts (incisions) are made in the abdominal wall to remove the affected portion of bowel or to restore circulation and renal vascularity of parts of looped intestine.

A sigmoid volvulus is a medical emergency that requires immediate evaluation and treatment by a medical professional.

The best doctor to consult for sigmoid volvulus is a gastrointestinal (GI) specialist or colorectal surgeon. These doctors specialise in diagnosing and treating conditions involving the digestive tract and rectum, including sigmoid volvulus.

• Laxatives:Laxatives help to soften stools and bulk stools in the intestines, which can aid in relieving symptoms of sigmoid volvulus.
• Antispasmodic drugs:These drugs help relax the muscles of the digestive system, providing relief from abdominal pain and spasms, which is often caused by sigmoid volvulus. Examples include dicyclomine, belladonna alkaloids and hyoscine (scopolamine).
• Anti-inflammatory drugs:Non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and decrease inflammation in the intestines.
• Antiemetics:These drugs are used to control vomiting that can occur due to bowel obstruction associated with sigmoid volvulus. Examples include antihistamines like promethazine or ondansetron and prochlorperazine (Compazine).
• Prokinetic agents:These drugs promote movement of food through the intestines in order to relieve symptoms associated with sparse intestinal motility caused by bowel obstruction from sigmoid volvulus. Examples include metoclopramide and domperidone.

Recovery from a sigmoid volvulus can take several days to several weeks, depending on both pre-existing health factors and the severity of the episode.

Generally, patients are discharged from the hospital within 4-7 days of diagnosis if medically stable. After discharge from hospital, most people continue to need recovery time at home for 2-4 weeks until their symptoms are resolved.

Generally speaking, the results of treatment are permanent; while some patients may experience recurrent symptoms after initial treatment, they can usually be managed with lifestyle modifications and medications.

However, in cases where bowel resection is required as part of treatment for sigmoid volvulus, recurrent symptoms may still occur due to scar tissue formation that can lead to re-twisting of the intestine.

• Monitor for signs of infection, such as fever, redness and swelling around the incision site.
• Provide a healthy balanced diet with adequate hydration and fluids for optimal recovery.
• Observe regular bowel movements or predispose medication to help ensure regularity.
• Maintain bed rest and decrease physical activity/exercise levels until there is no longer pain at the surgical site or until told otherwise by a physician/surgeon.
• Visit a doctor regularly to check on the patient's progress and prior to restarting any physical activity/exercise levels (at least six weeks after surgery).

The cost of treatment for Sigmoid volvulus in India will vary depending on the specific treatment required.

Generally, endoscopic treatments are more affordable than open surgery, with laparoscopic approaches being the least expensive.

Endoscopic treatments can range from INR 10,000-30,000 while laparoscopic and open surgery costs may range between INR 30,000-1.5 lakhs or more.

• Potential complications from sigmoid volvulus treatments include abdominal pain, infection, sepsis and haemorrhage from the site of the surgery.
• Post-operatively, patients may experience reduced intestinal function with constipation or diarrhoea.
• Adverse effects of medications are uncommon but may include nausea, vomiting, headaches or drowsiness.

If you are suffering from any complications relating to sigmoid volvulus then you should consult a doctor nearby as they can cause complications like 'intestinal obstruction, peritonitis, ischemia' in which treatment course can range from a few months to years depending on the severity of the situation.