Chang Chih-Jung, Hsieh Tsung-Hung, Tsai Kuang-Chau, Fan Chieh-Min
Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
J Emerg Med. 2013 Mar;44(3):611-3. doi: 10.1016/j.jemermed.2012.02.084. Epub 2012 Oct 15.
Volvulus of the sigmoid colon is a potentially life-threatening condition rarely seen in younger age groups and is male predominant.
We report a previously healthy young woman with the triad of constipation, progressive abdominal distension, and severe abdominal pain, with plain-film x-ray studies mimicking stool impaction and computed tomography disclosing the typical findings of sigmoid volvulus. The case reminds Emergency Physicians to consider sigmoid volvulus if mechanical obstruction is suspected, even in a young patient.
A 33-year-old woman had the triad of symptoms for 3 days. Physical examination did not show peritoneal signs. Digital rectal examination disclosed neither palpable mass nor stool in rectum. Computed tomography revealed "coffee bean" sign and "whirl" sign. Laparoscopy demonstrated redundant sigmoid colon and she was treated with detorsion with colopexy uneventfully.
Sigmoid volvulus is rarely seen in developed countries. Clinical manifestations vary with disease progression, but it typically presents with a triad of constipation, progressive abdominal distension, and severe abdominal pain. Plain-film x-ray studies can demonstrate a coffee bean or "omega loop" (inverted-U sigmoid) sign in <60% cases, but it was reported as high as 86% in computed tomography. The whirl sign on computed tomography might also be observed. The cause is multifactorial and colonic length is the most important predisposing factor. Flexible colon fiberscopic decompression followed by elective definitive surgery is the treatment choice, but exploratory laparotomy is mandatory if any complicated entity occurs. The mortality rate is still >50% when bowel gangrene develops.
乙状结肠扭转是一种潜在的危及生命的疾病，在较年轻年龄组中很少见，且男性居多。
我们报告一例既往健康的年轻女性，出现便秘、进行性腹胀和严重腹痛三联征，腹部平片检查结果类似粪便嵌塞，而计算机断层扫描显示乙状结肠扭转的典型表现。该病例提醒急诊医生，即使是年轻患者，怀疑机械性肠梗阻时也应考虑乙状结肠扭转。
一名33岁女性出现上述三联征症状3天。体格检查未显示腹膜刺激征。直肠指检未触及肿块，直肠内也未触及粪便。计算机断层扫描显示“咖啡豆”征和“漩涡”征。腹腔镜检查发现乙状结肠冗长，对其进行扭转复位加结肠固定术，术后恢复顺利。
乙状结肠扭转在发达国家很少见。临床表现随疾病进展而变化，但通常表现为便秘、进行性腹胀和严重腹痛三联征。腹部平片检查在不到60%的病例中可显示咖啡豆或“ω袢”（倒U形乙状结肠）征，但计算机断层扫描报告显示该比例高达86%。计算机断层扫描上也可能观察到漩涡征。其病因是多因素的，结肠长度是最重要的易感因素。治疗选择为先行柔性结肠纤维内镜减压，然后择期行确定性手术，但如果出现任何复杂情况则必须进行剖腹探查。发生肠坏疽时死亡率仍>50%。
