Volvulus of the sigmoid colon in Brazil: a report of 230 cases

Etiologic and physiopathologic aspects of volvulus of the sigmoid colon in Brazil are presented. It is believed that sigmoidal volvulus in Brazil is a frequent complication of megacolon caused by Chagas' disease, differing in some characteristics from volvulus found in other countries. A review of 230 cases treated between 1938 and 1974 in the Surgical Department of Hospital das Clinicas, University of Sao Paulo School of Medicine, is presented. The successive variations used to treat this disease occurred parallel to those introduced in the surgical treatment of uncomplicated megacolon. From the results, the following treatment is recommended: endoscopic emptying in cases without clinical, roentgenographic or endoscopic signs of intestinal ischemia. Laparotomy should be performed when a complicated volvulus is suspected or when it is not possible to empty the loop. When a simple volvulus is found, the loop should be untwisted and the gaseous contents siphoned off by menas of a rectal catheter. When there is necrosis of the colon, the Hartmann operation is recommended. It is important to submit patients to a definitive treatment of the megacolon soon after endoscopic emptying or surgical detorsion of the volvulus, since recurrences following these measures are frequent.