Snapshot quiz 11/7

Published: 05/29/2012

Authors: Jadav AM, Thrumurthy SG and Bhowmick AK

This shows a massively dilated, infarcted sigmoid volvulus in a previously healthy 70-year-old man, who presented with a week-long history of abdominal distension and complete constipation. Computed tomography revealed a sigmoid convolvulus but due to the degree of abdominal tenderness, high inflammatory markers and features of sepsis, a laparotomy and Hartmann’s procedure was performed instead of endoscopic decompression. It has a wide geographical and racial distribution and although relatively common in certain developing countries, it has a much lower incidence in the West, where it is responsible for up to 10 per cent of cases of large bowel obstruction. Predispasing factors include chronic constipation, increasing age and institutionalization. Uncomplicated presentations are managed initially with correction of fluid and electrolyte imbalances and urgent endoscopic decompression. Indications for surgery include clinical or colonoscopic features of bowel ischaemia, and failed decompression. The overall mortality is up to eight times higher when colonic infarction is present.