CONCOMITANT PRESENTATION OF VOLVULUS OF THE SIGMOID COLON WITH RECTAL CANCER: A CASE REPORT Vina Dwitia
General Surgeon of Dustira Army Hospital, West Java, Indonesia
Surgery Lecturer of Medical Faculty Jenderal Achmad Yani University,
West Java, Indonesia
Abstract
Sigmoid volvulus is one of the three most common causes of acute colonic obstruction. Predisposing factors to sigmoid volvulus include chronic constipation, megacolon, and an excessively mobile colon. However, concomitant presentation of volvulus of the sigmoid colon and rectal cancer is extremely rare. We report a case of a 38-year-old woman with coexisting volvulus of the sigmoid colon and rectal cancer. The patient presented with abdominal distension, pain, vomiting for 3 days. She had history of abdominal distention several times in the past 1,5 months. On Abdominal X-Ray, the whole colon was dilated with gas . There were multiple air fluid level with gas above ^stepladder pattern^. Exploratory laparotomy was performed. We found extremely dilated both small and large bowel. The sigmoid colon was rotated around its mesentery. The sigmoid colon was redundant. It was severely distended with oedematous, hyperaemic serosa. Stricture mid rectum due to shrinkage tumour was identified in the proximal-rectum. The patient underwent decompression (ileotomy) , sigmoid resection, tumour biopsy and colostomy mucous fistulas. Pathologic findings confirmed adenocarcinoma of the rectum. The postoperative course was good. The patient came home and have been reffered to Digestive Surgeon for chemotherapy and planned for definitive surgery ( Low Anterior Resection).
