Dr. Roach: Twisted colon is a surgical emergency
Dear Dr. Roach: This past weekend, during my son’s wedding festivities, I experienced a sigmoid volvulus. Doctors recommended surgery, but I opted for a colonoscopy, which was performed successfully. Thank goodness. I was immediately a new woman, and no one would have dreamed I went through this emergency. The surgeons recommended I have my sigmoid colon removed in order to decrease the risk of recurrence. Ideally, this would happen as soon as possible.
What could have prompted the sigmoid volvulus? Is it an absolute that I must have my sigmoid colon removed? What are the odds of it recurring? If I do need the surgery, how can I best prepare for it, and what are the side effects?
Dear M.B.: A volvulus is the twisting of a hollow structure in the body around its long axis (imagine holding one end of a sock in each hand and flipping the middle so it twists on itself). The sigmoid colon is the most common location. It is a surgical emergency, as tissue death and gangrene may follow.
The biggest risk factor for volvulus is chronic constipation, but some people just have anatomy that predisposes them to get a volvulus.
Surgery is the definitive treatment, but colonoscopy or sigmoidoscopy may be used to untwist the colon; medical professionals use the term “reduce.” However, your surgeon was right that you are at risk for this happening again. In those people with a history of volvulus, 50% to 60% will get another, and if you have two, the recurrence rate is even higher.
For a person in generally good health, I would recommend definitive surgery to prevent recurrence of volvulus. There are no specific instructions to prepare for surgery, beyond taking good care of yourself and following your surgeon’s instructions about your medications (if any).
Any abdominal surgery has the risk of bleeding, infection and adhesions (connections between loops of bowel that can lead to painful obstruction later); however, these risks are quite small.
Dear Dr. Roach: I read your recent column on cramping and constipation. A few months ago I had a period of being constipated, and my wife told me to take a laxative. It worked. A few days later, I had to take it again, and again on and off for a month. Then I remembered something my mom once said to me: She told me to eat a couple of prunes a night. That worked. Now I am 84 years old, and my wife and I eat one or two prunes every night. Let me tell you, they work.
Is this good for us? Can we keep eating them every day? I think they must be healthier than the laxatives.
Dear R.P.: Prunes are a time-tested constipation treatment that work for a lot of people. Prunes not only contain fiber, but they contain natural laxatives as well. They also have a fair bit of sugar, but one or two a night is not enough to be worried about. I agree with you that prunes are a good alternative to over-the-counter laxatives for many people.
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