FOUR patients having acute obstruction due to volvulus of the sigmoid and 1 patient having acute obstruction due to volvulus of the cecum have served to emphasize certain diagnostic and therapeutic points.
In volvulus of the sigmoid, in older patients, there is usually a history of repeated attacks of partial obstruction or of constipation, while in younger patients the acute obstruction often occurs without any previous history.1 The obstruction may be of many hours' duration, but the patient is not so sick as one might expect with carcinoma. The hemoglobin value and the red blood cell count are usually not much below normal. The abdomen is apt to be markedly distended. There may be little vomiting. There is pain over the dilated loop and especially where the twist puts a pull on the root of the mesentery. This pain will be severe if there is much interference with circulation.