TITLE:
Observations on a Giant Sigmoid Volvulus with Unusual Clinical Presentation and Challenging Postoperative Course: Case Report
AUTHORS:
Giuseppe Pisano, Pietro Giorgio Calò, Stefano Piras, Enrico Erdas
KEYWORDS:
Sigmoid Volvulus, Toxic Megacolon, Abdominal Compartment Syndrome
JOURNAL NAME:
Surgical Science,
Vol.6 No.11,
November
13,
2015
ABSTRACT: Introduction:
The present report describes a case of a giant sigmoid volvulus (SV) where
acute respiratory distress was associated with toxic megacolon. Clinical
features, surgical treatment and postoperative course deserved our attention
and discussion. Presentation of Case: A 67-year-old man with psychiatric
disturbances was admitted to our Department with severe respiratory distress
due to an enormous abdominal distension caused by a sigmoid volvulus. Endoscopic
derotation was unsuccessful and surgery immediately performed. After a wide
colonic resection the patient underwent a prolonged treatment in the Intensive
Care Unit. Death occurred 34 days after the operation for secondary infection
of peritoneal effusion. Discussion: Main clinical features of SV pertain to
abdominal compartment while in the present case acute respiratory distress was
the prominent symptom; in the same time the severity of the case was due to the
association of high abdominal pressure together with a toxic megacolon.
Postoperative treatment consisted in ventilatory support, with a progressive
shift from asssisted to spontaneous ventilation; repeated sessions of
haemodialysis were necessary to manage renal failure up to recovery of the
urine output. Bacterial trans location due to toxic megacolon was responsible
of late infection of ascitic fluid. In spite of multiple antibiotic association
according to bacterial cultures, intra-abdominal abscesses eventually developed
causing fatal outcome 34 days after the first intervention. Conclusion: Severe
clinical presentation required a prolonged and demanding postoperative course
which was focused on the recovery of respiratory, cardiac and renal function
even if fatal outcome was due to septic complications. Suspicion of late
infection of ascitic fluid could arise from persistently high values of
inflammation indexes and drive to an earlier drainage of the abdominal
abscesses.