Patient's Query
Hi doctor,
My father recently had sigmoid volvulus. His colon was untwisted during a sigmoidoscopy. However, we understand that without surgery, there is a high recurrence rate, which we are concerned about. We have been told that the two treatment options are
A) Securing the bowel to the mesentery.
B) Removing the short section of the bowel that is prone to twisting.
My questions are if a short section of bowel is removed, is a colostomy bag always fitted, or can it be done without one?
When a colostomy is later reversed, and the two sections of the colon are connected back together, does not this present the same problem of feces passing through a section of the bowel that has been operated on before it has had time to heal? So, what is the point of fitting the colostomy bag in the first place? Please help.
Thank you.
Hello,
Welcome to icliniq.com.
The treatment of sigmoid volvulus depends on the general health of the patient and the nature of presentation. In an elderly patient with multiple comorbid illnesses or who is unfit for anesthesia, the preferred modality is endoscopic (colonoscopic).
The recurrence rate of this has to be accepted. If the patient is fit for surgery, it can be either suture fixed or resected (The redundant segment). In an unstable patient, especially in an emergency, the chances of healing are reduced. Then a stoma is opted for temporary diversion, in order to facilitate a safe anastomosis of the intestine later.
In a relatively stable patient, an upfront primary joining of the intestinal ends can be done. The proper healing of the same will allow the smooth passage of contents. A stoma is not always needed. It is used only when a primary anastomosis is unsafe. The present scenario: endoscopy is the safest option considering age and comorbidities. Avoid constipation at any cost, as it predisposes to volvulus.
Hope your queries have been cleared.
Kindly revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
Is there any physiotherapy or training available for patients regarding types of body movement or activities they should avoid to limit the risk of recurrence (for example, should they avoid bending forward to tie shoelaces)? How can a recurrence be quickly identified?
Presumably, constipation would indicate possible recurrence, and if it persisted, should we contact our GP? How long should we wait before contacting a GP if constipation occurs?
Thank you.
Hello,
Welcome back to icliniq.com.
As far as I know, there are no physical movements shown to predispose to volvulus. Make sure he has a good bowel movement at least once a day. The stool should be soft. He should avoid constipating foods. Consume a good amount of water, up to two liters a day. Any worsening of constipation should be consulted with your GP (general practitioner).
I hope this helps.
Kindly revert in case of further queries.
Thank you.
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