Sigmoidal volvulus in young adult patients

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Within a year, five young adult patients of Western origin, aged 19 to 24 years, were admitted because of sigmoidal volvulus. The chronic, intermittent course of the disease was manifested by abdominal pain, distention and chronic constipation, which lasted for periods ranging from four to 20 years before the condition was recognized and treated. Nonoperative reduction by proctoscopy, rectal tubes or therapeutic barium-enema was successful in treating four patients. These measures are recommended as initial treatment provided there is no sign of peritonitis. When operative treatment is indicated, and there is no sign of gangrene, the recommended procedure involves simple detorsion followed by elective sigmoidal resection at a later stage. Elective sigmoidal resection after proper bowel preparation was eventually performed in all five of our cases. There was no death. A fecal fistula developed in one patient after emergency Mikulicz resection and reanastomosis. The realization that chronic, intermittent sigmoidal volvulus is not as uncommon in young adults as is generally assumed may prevent delay in diagnosis and avoid the danger of complete obstruction and gangrene of the colon.

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