#25 Sigmoid Dyskinesia

Study #25

Here we introduces the concept of sigmoid dyskinesia. This term is not in the title because it’s use was discouraged by the editor of the journal. However obstructing adhesions to the sigmoid colon create a severe form of IBS that needs surgery. This is an important truth that is still ignored by most gastroenterologists and even surgeons.

Jarrar A, Church J. Treating symptomatic adhesions to the sigmoid colon: colectomy quality of life. Int J Colorectal Dis: 2013; 28: 1407-1411.

Introduction: When severe chronic pelvic pain, constipation, and bloating are due to dense pelvic adhesions fixing the sigmoid loops, patients may be offered the option of sigmoid colectomy. This study examines the effectiveness of colectomy in the treatment of such patients.

Methods: Patients were identified from a surgical database, demographic data were abstracted, and charts were reviewed. Patients were interviewed postoperatively. Primary end points were morbidity, length of stay, change in bowel habit, and patient satisfaction.

Results: There were 46 patients (44 women) with a mean age of 54.7 years (±14.3). Forty-three had a history of prior pelvic surgery (93%), including 30 (65%) with hysterectomy. One quarter had been diagnosed with irritable bowel syndrome. Surgery revealed adhesive tethering of the sigmoid colon in 43 patients (94%). Mean length of stay was 6.5 days (±2.5), and complications occurred in eight (17.3%) patients. There were no deaths, and no patients required a stoma. Follow-up in 37 patients after mean of 7.2(±5.0) years showed significant reductions in abdominal pain and bloating postoperatively, with normalization of bowel function and increase in quality of life.

Conclusion: When severe lower abdominal pain and bloating in women who have had pelvic surgery are reproduced by colonoscopy, and there is an obvious kink in the bowel, sigmoid colectomy is worth considering.