PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：肠扭转是指胃肠道一部分的扭转或旋转扭转，倾向于影响盲肠和乙状结肠，经常导致肠梗阻的发展。相关的危险因素是老年，慢性粪便嵌塞，精神疾病,结肠运动障碍,先前的腹部外科手术程序，糖尿病,和先天性巨结肠的病。老年人最常受到乙状结肠扭转的影响，但在年轻人中很少有严重并发症的病例。虽然很罕见,但是表现为乙状结肠扭转继发的急腹症的年轻人需要紧急关注。为了防止更具侵入性的外科手术，随着患者的完全恢复，内镜下的治疗是首选。我们介绍了一例年轻女性，她成功地通过内窥镜矫正进行了治疗。
方法：27岁亚裔巴基斯坦女性出现腹胀恶化，便秘和呕吐2天以来。经检查，她发烧了，非常稳定。腹部扩张，鼓室敲击伴全身压痛。获得腹部X线片，显示肠loop扩张，然后进行腹部计算机断层扫描，提示乙状结肠扭转引起肠梗阻。患者立即转移到内窥镜检查单元，并进行内窥镜扭转。对于出现乙状结肠扭转且未出现腹膜炎或结肠坏疽迹象的个体，推荐的行动方案包括急性内镜下的扭转术,其次是预定的手术干预。
结论：本病例报告强调了临床医生在评估年轻和其他健康患者腹痛时将乙状结肠扭转视为一种罕见但重要的原因的重要性。诊断和治疗延迟超过48小时会导致结肠坏死，放大相关的发病率和死亡率。迅速的干预对于减轻这些并发症并获得决定性的补救措施至关重要。
方法：27岁亚裔巴基斯坦女性出现腹胀恶化，便秘和呕吐2天以来。经检查，她发烧了，非常稳定。腹部扩张，鼓室敲击伴全身压痛。获得腹部X线片，显示肠loop扩张，然后进行腹部计算机断层扫描，提示乙状结肠扭转引起肠梗阻。患者立即转移到内窥镜检查单元，并进行内窥镜扭转。对于出现乙状结肠扭转且未出现腹膜炎或结肠坏疽迹象的个体，推荐的行动方案包括急性内镜下的扭转术,其次是预定的手术干预。
结论：本病例报告强调了临床医生在评估年轻和其他健康患者腹痛时将乙状结肠扭转视为一种罕见但重要的原因的重要性。诊断和治疗延迟超过48小时会导致结肠坏死，放大相关的发病率和死亡率。迅速的干预对于减轻这些并发症并获得决定性的补救措施至关重要。
