A Lesson to Learn in an Iatrogenic Perforation of Sigmoid Volvulus after Endoscopic Derotation

  • Pauline Yap Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  • Firdaus Hayati Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  • Nik Amin Sahid Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  • Nornazirah Azizan Department of Pathobiology and Medical Diagnostic, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  • Fairrul Kadir Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  • Andee Dzulkarnaen Zakaria Department of Surgery, School of Medicine, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
  • Nik Qisti Fathi Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Keywords: Sigmoid colon, volvulus, colonoscopic surgical procedure, iatrogenic disease

Abstract

A 78-year-old gentleman was diagnosed with stable sigmoid volvulus after complaining of acute abdominal pain with no bowel opening for a week. Abdominal radiography confirmed the diagnosis after showing a typical coffee bean sign. Opting for conservative management, an urgent endoscopic reduction was attempted with insertion of flatus tube and achieved successfully. However, the flatus tube dislodged in the ward and reinsertion was attempted without direct vision. Patient’s condition deteriorated and computed tomography of the abdomen revealed an extensive pneumoperitoneum requiring urgent laparotomy. Massive faecal contamination was visualized with evidence of a sharp tip of the flatus tube piercing through the sigmoid colonic wall. Hartmann's procedure was performed. However, he deteriorated despite the surgery. He succumbed 3 days after the operation. We describe a case of a successful endoscopic derotation of sigmoid volvulus with iatrogenic bowel perforation after reinsertion of flatus tube.

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Published
2019-03-25