Sigmoid volvulus: mischief from a gravid uterus
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Author(s)
Bong, Christopher Y
Yuide, Peter J
Burstow, Matthew J
Chua, Terence C
Year published
2019
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A 39‐year‐old gravida 2 para 1 female at 32 weeks gestation presented with 3 days of abdominal pain, distension, nausea and diarrhoea. Her presentation was associated with tenesmus and anorexia. Her past history was significant for an elective laparoscopic left‐sided pyeloplasty for congenital pelviureteric junction obstruction. On examination, the patient was afebrile and haemodynamically stable. The foetus was not distressed according to cardiotocography assessment. Her abdomen was distended and tympanic with generalized tenderness. Bowel sounds were high pitched and tinkling. A digital rectal examination revealed an empty ...
View more >A 39‐year‐old gravida 2 para 1 female at 32 weeks gestation presented with 3 days of abdominal pain, distension, nausea and diarrhoea. Her presentation was associated with tenesmus and anorexia. Her past history was significant for an elective laparoscopic left‐sided pyeloplasty for congenital pelviureteric junction obstruction. On examination, the patient was afebrile and haemodynamically stable. The foetus was not distressed according to cardiotocography assessment. Her abdomen was distended and tympanic with generalized tenderness. Bowel sounds were high pitched and tinkling. A digital rectal examination revealed an empty rectum with no masses or faeces. The patient was hypokalaemic and hyponatraemic at 3.1 and 129 mmol/L, respectively. Her white cell count was 20.3 × 109/L, of which 17.87 × 109/L were neutrophils. Abdominal plain films were concerning for a large bowel obstruction, with marked distension of large bowel proximal to the descending colon and an absence of gas in the left lower quadrant (Fig. 1). A nasogastric tube was placed with minimal effect on symptomology and a magnetic resonance imaging (MRI) was performed. This demonstrated spiralling of the sigmoid colon at the transition point of the obstruction, concerning for a sigmoid volvulus (Figs 2, 3). Initial attempt at decompression with rigid sigmoidoscopy failed. Colonoscopic decompression was performed, successfully reducing the volvulus. The entire length of colon had viable mucosa on endoscopic examination. A flatus tube was placed during the procedure and removed on the following day. Her condition improved, and she was discharged on the third day.
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View more >A 39‐year‐old gravida 2 para 1 female at 32 weeks gestation presented with 3 days of abdominal pain, distension, nausea and diarrhoea. Her presentation was associated with tenesmus and anorexia. Her past history was significant for an elective laparoscopic left‐sided pyeloplasty for congenital pelviureteric junction obstruction. On examination, the patient was afebrile and haemodynamically stable. The foetus was not distressed according to cardiotocography assessment. Her abdomen was distended and tympanic with generalized tenderness. Bowel sounds were high pitched and tinkling. A digital rectal examination revealed an empty rectum with no masses or faeces. The patient was hypokalaemic and hyponatraemic at 3.1 and 129 mmol/L, respectively. Her white cell count was 20.3 × 109/L, of which 17.87 × 109/L were neutrophils. Abdominal plain films were concerning for a large bowel obstruction, with marked distension of large bowel proximal to the descending colon and an absence of gas in the left lower quadrant (Fig. 1). A nasogastric tube was placed with minimal effect on symptomology and a magnetic resonance imaging (MRI) was performed. This demonstrated spiralling of the sigmoid colon at the transition point of the obstruction, concerning for a sigmoid volvulus (Figs 2, 3). Initial attempt at decompression with rigid sigmoidoscopy failed. Colonoscopic decompression was performed, successfully reducing the volvulus. The entire length of colon had viable mucosa on endoscopic examination. A flatus tube was placed during the procedure and removed on the following day. Her condition improved, and she was discharged on the third day.
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Journal Title
ANZ Journal of Surgery
Copyright Statement
© 2019 Royal Australasian College of Surgeons. This is the peer reviewed version of the following article: Sigmoid volvulus: mischief from a gravid uterus, ANZ Journal of Surgery, 2019, which has been published in final form at https://doi.org/10.1111/ans.15466. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)
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This publication has been entered into Griffith Research Online as an Advanced Online Version
Subject
Clinical sciences