Torabi Hossein, Shirini Kasra, Ghaffari Rona
Department of General Surgery, Poursina Medical and Educational Center, Guilan University of Medical Sciences, Rasht, IRN.
Department of General Surgery, Iran University of Medical Science, Tehran, IRN.
Cureus. 2021 Dec 7;13(12):e20250. doi: 10.7759/cureus.20250. eCollection 2021 Dec.
Volvulus of the colon is the third important reason for colon obstruction, which can occur in different parts of the colon for various reasons and can lead to ischemia and necrosis of the colon wall tissue. In this article, we are going to describe a simultaneous sigmoid and colon volvulus which was operated on with suspicion of sigmoid volvulus. A 72-year-old patient presented with suddenly severe generalized abdominal pain with a past medical history of inflammatory bowel disease (IBD) and prolonged constipation who underwent laparotomy for suspected colonic volvulus. During the operation, it was found that transverse colon volvulus occurred simultaneously with sigmoid colon volvulus with colon necrosis along its length. Therefore, a total colectomy with ileorectal anastomosis was performed. After one week, the patient was discharged from the surgical ward after tolerating feeding and with stable vital signs. The simultaneous transverse colon and sigmoid volvulus is a rare phenomenon, and there are several ways to diagnose and evaluate this situation. However, none of them can help us diagnose this disease. Unfortunately, no specific algorithm has been designed for the approach in this situation, and it all depends on the patient's condition. Simultaneous occurrence of the sigmoid and transverse colon can make a high-risk emergency condition that could threaten the patient's life. Therefore, paying attention to the patient's symptoms and patient's condition and clinical findings, with high accuracy and speed and subsequently selecting the best surgical technique, if surgery is necessary, and according to the finding during surgery, especially the extent of necrotic tissue, the most crucial issue in treating the patient.
结肠扭转是结肠梗阻的第三个重要原因,可因各种原因发生在结肠的不同部位,并可导致结肠壁组织缺血和坏死。在本文中,我们将描述一例因怀疑乙状结肠扭转而接受手术的同时发生的乙状结肠和结肠扭转病例。一名72岁患者,既往有炎症性肠病(IBD)病史且长期便秘,因疑似结肠扭转而出现突然剧烈的全腹痛,接受了剖腹手术。手术中发现横结肠扭转与乙状结肠扭转同时发生,且结肠全长均有坏死。因此,进行了全结肠切除术并回肠直肠吻合术。一周后,患者在耐受进食且生命体征稳定后从外科病房出院。同时发生的横结肠和乙状结肠扭转是一种罕见现象,有几种诊断和评估这种情况的方法。然而,没有一种方法能帮助我们诊断这种疾病。不幸的是,针对这种情况尚未设计出具体的算法,这一切都取决于患者的病情。乙状结肠和横结肠同时发生扭转可导致高风险的紧急情况,可能威胁患者生命。因此,关注患者的症状、病情和临床检查结果,以高准确性和速度进行诊断,随后选择最佳的手术技术(如有必要进行手术),并根据手术中的发现,特别是坏死组织的范围,是治疗患者的最关键问题。