Vadim Meytes, DO, Nicholas Morin, DO, Steven Schulberg, DO, Esther Adler, MD, Galina Glinik, MD, Anthony Kopatsis, MD. NYU Lutheran Medical Center
Sigmoid volvulus is a surgical emergency treated initially with decompression via colonoscopy before advancing to surgical correction.
Severe hypothyroid presenting with colonic dilation is a phenomenon known as myxedema pseud-ovolvulus.
However, if the patient presents late in the course, surgical management is needed followed by replacement of thyroid hormone.
Case Presentation #1:
Patient is a young Asian male with a chief complaint of 3 days of increasing abdominal pain and distension leading to constipation and eventually obstipation.
Physical exam: extreme abdominal distention, + rebound/guarding
CT scan findings were consistent with massive colonic dilatation and volvulus
The patient was taken emergently to the OR for sigmoidectomy.
A large dilated sigmoid colon with a point of torsion with a dense adhesion in the small bowel mesentery was found
Thyroid panel to evaluate chronic constipation was sent with the following findings: TSH: >150 mc/ml, Free T3: <.2pg/ml, Free T4: .12 ng/dl.
Patient was started on thyroid replacement and had return to normal bowel function
Case Presentation #2:
Patient is a young Asian male with chief complaint of 2 week history of bloating and increasing abdominal pain. 8/10 intensity.
Physical exam significant for extreme abdominal distention and tympanic abdomen.
Abdominal X-ray and CT scan findings significant for sigmoid dilatation and volvulus.
TSH: 24.6, Free T4: .71
Patient was decompressed via colonoscopy. After bowel prep was performed. Patient underwent a second colonoscopy where no masses were noted.
Thyroid hormone was replaced and patient had resolution of the volvulus with return to normal bowel function. Patient was discharged with medical and surgical follow-up.
There are several case reports in the literature of hypothyroid myxedema causing colonic pseudo-obstruction presenting with megacolon.
It is thought that the megacolon is due to decreased peristalsis and increased edema of the bowel directly related to the deposition of hydrophilic glycoprotein and lymphoid aggregates in the colonic wall.
Sigmoid volvulus is a rare late complication of severe hypothyroidism.
Surgical management should be coupled with hormone replacement.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77438
Program Number: P158
Presentation Session: Poster (Non CME)
Presentation Type: Poster