[Dolichomegacolon of the Andes and intestinal volvulus due to altitude].
Sigmoid volvulus is a frequent cause of emergencies in hospitals in the Andean area, representing more than 50% of all intestinal obstructions. Andean dolichomegacolon (DCMA) and retractile mesocolonitis are the main contributing factors for volvulus. The mesocolonitis nears the proximal and distal segment of the sigmoid handle, favoring its torsion. Copious intake of fermentable food is the precipitating factor for volvulus. The majority of patients are seen during sowing and harvest periods, in which the consumption of this type of food increases. Andean people who live at an altitude of 3,000 m have a larger and thicker colon than coastal residents. We call this acquired characteristic the Andean dolichomegacolon (DCMA). A fiber-rich diet may inhibit the histological phenomenon known as elastogenesis, developing--over the years--the megacolon. Another important factor may be the lower atmospheric pressure in the altitude, and according to Boyle and Mariotte's physical law, the expansion of intraluminal gas may have an influence on intestinal enlargement. DCMA has many special anatomic, clinical, radiological, histological and serological features which make it different from the . chagasic megacolon. Mild emergency procedures may be performed to treat the sigmoid volvulus, such as endoscopic disvolvulation. Changing the colon rotation is helpful in diminishing abdominal pressure and restore complete blood circulation. An emergency surgery treatment must take the patient's general condition and the colon handle condition during surgery as a guiding point. High rates of mortality are found in relation to elderly patients, disease evolution time and stage of intestinal ischemia. Other new therapeutic procedures such as percutaneous sigmoidpexy, laparoscopic sigmoidectomy and mesosigmoplasty are under review, and have precise indications. Wider series are needed to evaluate them better.
Frisancho
Oscar
O
Medicó Gastroenterólogo, Hospital Nacional Edgardo Rebagliati Martins-EsSALUD, Lima Perú. ofrive@hotmail.com
D000368:Aged; D000465:Algorithms; D000531:Altitude; D004032:Diet; D004630:Emergencies; D005843:Geography; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D045822:Intestinal Volvulus / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D010535:Laparoscopy; D007813:Laparotomy; D008531:Megacolon / Q000145:classification / Q000150:complications* / Q000175:diagnosis / Q000209:etiology*; D010568:Peru; D012810:Sigmoid Diseases / Q000209:etiology* / Q000601:surgery / Q000628:therapy