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Sigmoid volvulus in children is quite rare and may occur in acute fulminating form requiring early diagnosis and surgery. In this case, bowel continuity after resection of the necrotic sigmoid was reestablished in a two-stage operation.
Patients with lower abdominal symptoms, indicating colonic disorder, were classified into predefined clinical syndromes. Two important syndromes were colicky sigmoid syndrome and chronic diverticular disease. The first one, characterized by presence of colicky lower abdominal pains but absence of colonic diverticula, probably covers what is generally referred to as 'irritable bowel syndrome'. The second one was characterized by presence of lower abdominal colics and of colonic diverticula. The results showed a significant correlation between the presence of lower abdominal colics and a high pressure activity in the sigmoid colon after intravenous neostigmine. There was, however, no correlation between the presence of diverticula and a high pressure activity. The generally accepted theory of a high pressure activity as the dominant factor in the pathogenesis of colonic diverticula, therefore, was questioned, as was the equally accepted theory of a gradual development of chronic diverticular disease from the adiverticular colicky sigmoid syndrome.
Previous reports show evidence that perforation of the sigmoid colon with diffuse peritonitis, when conventionally treated (i.e. by suture, drainage, and proximal defunctioning colostomy) is associated with a high mortality. Recent investigations, however, indicate that the mortality can be lowered considerably if acute resection or exteriorization of the affected segment of the bowel is performed. Fifteen patients with perforated lesions in the sigmoid colon associated with diffuse peritonitis were treated with drainage and right transverse colostomy during the 10-year period 1963-72 with five deaths. In comparison, during the last years, ten patients with perforation and diffuse peritonitis were treated with acute resection or exteriorization of the affected segment of the bowel without any mortality. Though the two patient series are not completely comparable, the results imply that removal or exteriorization of the affected bowel is to be preferred in the surgical treatment of most perforated lesions in the sigmoid colon, even if the perforation is associated with diffuse peritonitis.
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Double tracking of barium in the sigmoid colon has been associated with granulomatous colitis by some; others consider it a sign of peridiverticulitis. Patients who showed no evidence of inflammatory disease elsewhere in the large intestine were analysed. The pathological diagnosis was diverticulitis in 29 of 35 cases, and granulomatous diverticulitis in only 1. In 5 the underlying process was perforated carcinoma of the sigmoid colon. In those with paracolonic sinus tracts due to peridiverticulitis, pathological study demonstrated tracts extrinsic to the muscularis and usually traceable to a perforated diverticulum. Long-term follow-up disclosed no evidence of subsequent inflammatory bowel disease.
A ten-year study of volvulus of the sigmoid colon is presented. Although the results of treatment of volvulus of the sigmoid colon are generally improving, the challenge for further improvement remains.
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Colonic diverticulitis can produce gas in the portal and inferior mesenteric veins. Such an occurrence is usually associated with massive bowel necrosis and carries a grave prognosis. The authors report a case in which the patient survived.
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