Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

1348 Sickle Cell Syndromes Sigmoid Volvulus

■SC patients are generally less severe than those with SS, and have a

life expectancy that is∼10 years longer. However, individual patients

may be extremely symptomatic with high rates of pain crises, etc.

■S/thalassemia patients can be very symptomatic if they have a beta 0

genotype (i.e., no hemoglobin A) and should be treated the same as

those with SS. Patients with a beta+genotype (i.e., some hemoglobin

A) are clinically more like those with SC disease.

SIGMOID VOLVULUS

BASSEM SAFADI, MD and ROY SOETIKNO, MD, MS

history & physical

Risk Factors

■elongated or narrow-based mesentery

■distended colon with gas and feces

■adhesions

■elderly male in chronic care

■chronic constipation

Symptoms & Signs

■rapid onset of lower abdominal pain, distention and obstipation

■prior episodes may be less severe

■abdominal distention and tympany

■fever, tachycardia and peritoneal signs in ischemia or perforation

tests

■abdominal X-ray: diagnostic in 40–50% of cases

■markedly distended sigmoid colon loop in the right upper quadrant

with both ends pointing to the left lower quadrant

■Gastrograffin or barium enema

■contrast in the rectum and distal sigmoid: tapers and ends at the

torsion

■abdominal and pelvic CAT scan can de diagnostic

differential diagnosis

■Obstruction from intra and extra colorectal malignancies

■Strictures

■Pseudo-obstruction

■Severe constipation