Aga Khan University Hospital, Karachi, Pakistan.
Department of Gastroenterology, Aga Khan University Hospital, Karachi, Pakistan.
J Med Case Rep. 2024 Aug 13;18(1):378. doi: 10.1186/s13256-024-04578-0.
A volvulus refers to the torsion or rotational twisting of a portion of the gastrointestinal tract, with a predilection for impacting the caecum and sigmoid colon, often resulting in the development of bowel obstruction. The risk factors associated are old age, chronic fecal impaction, psychiatric disorders, colonic dysmotility, prior abdominal surgical procedures, diabetes, and Hirschsprung's disease. Elderly are most commonly affected with sigmoid volvulus but there are few cases among young adults that culminate in grave complications. Although it is rare, but young individuals presenting with acute abdomen secondary to sigmoid volvulus need urgent attention. To prevent more invasive surgical procedures, endoscopic detorsion is preferred nowadays with complete recovery of patients. We present a case of young female who was successfully managed with endoscopic detorsion.
27 years old Asian Pakistani female presented with worsening abdominal distention, constipation and vomiting since 2 days. On examination she was afebrile, vitally stable. Abdomen was distended, tympanic percussion with generalized tenderness. Abdominal radiograph was obtained which showed dilated bowel loops followed by Computed tomography of abdomen which was suggestive of Sigmoid volvulus causing intestinal obstruction. Patient was immediately moved to endoscopy unit and endoscopic detorsion of volvulus was done. For individuals who present with sigmoid volvulus and do not exhibit signs of peritonitis or colonic gangrene, the recommended course of action involves acute endoscopic detorsion, followed by scheduled surgical intervention.
This case report emphasizes the significance of clinicians considering sigmoid volvulus as a rare but important cause when evaluating abdominal pain in young and otherwise healthy patients. A delay in diagnosis and treatment extending beyond 48 hours leads to colonic necrosis, amplifying the associated morbidity and mortality. Swift intervention is imperative to mitigate these complications and attain a conclusive remedy.
扭转是指胃肠道的一部分发生扭曲或旋转，常影响盲肠和乙状结肠，导致肠梗阻。其相关的危险因素有老年、慢性粪便嵌塞、精神障碍、结肠动力障碍、腹部手术史、糖尿病和先天性巨结肠。老年人最常发生乙状结肠扭转，但也有少数年轻成年人病例出现严重并发症。虽然很少见，但年轻个体因乙状结肠扭转引起的急性腹痛需要紧急关注。为了避免更具侵袭性的手术，现在更倾向于采用内镜复位，患者可完全康复。我们报告了一例成功通过内镜复位治疗的年轻女性病例。
一位 27 岁的亚裔巴基斯坦女性，因 2 天来腹痛加重、便秘和呕吐就诊。检查时，她无发热，生命体征稳定。腹部膨隆，呈鼓音，全腹压痛。腹部 X 线片显示肠腔扩张，随后行腹部 CT 检查提示乙状结肠扭转导致肠梗阻。患者立即被转至内镜科，行肠扭转内镜复位术。对于那些出现乙状结肠扭转且无腹膜炎或结肠坏疽征象的患者，推荐的治疗方法是急性内镜复位，然后再进行择期手术干预。
本病例报告强调了临床医生在评估年轻且健康的患者腹痛时，将乙状结肠扭转视为一种罕见但重要病因的重要性。诊断和治疗的延误超过 48 小时会导致结肠坏死，增加相关发病率和死亡率。迅速干预至关重要，可以减轻这些并发症并获得明确的治疗效果。
