Session Information
Date: Monday, June 20, 2016
Session Title: Parkinson's disease: Non-motor symptoms
Session Time: 12:30pm-2:00pm
Location: Exhibit Hall located in Hall B, Level 2
Objective: To study the outcomes of patients with Parkinson’s disease (PD) who were admitted with a diagnosis of sigmoid volvulus.
Background: Constipation is a common non-motor symptom in patients with PD. This leads to elongation and redundancy of the colon which may subsequently twist around itself producing a sigmoid volvulus. The incidence is 5-7% of patients with PD1. Recurrent volvulus leads to increased mortality (up to 40%) from gut ischaemia and perforation2.
Methods: Patients were identified through clinical coding. A retrospective analysis was then undertaken of clinical notes, radiography, discharge letters and clinic letters.
Results: A total of six patients were identified with the details outlined in table 1.
| Age (yrs) | Presentation | Bowel Habits | Previous admissions with volvulus | Imaging | Management | Length of stay (Days) | Outcome |
|---|---|---|---|---|---|---|---|
| 79 | Abdominal pain | Constipation | 0 | Abdominal x-ray (AXR) | Sigmoidoscopy | 20 | Alive |
| 89 | Abdominal pain | Constipation | 3 | AXR, CT scan | Sigmoidoscopy, Flatus tube | 1 | Alive |
| 94 | Abdominal distension | Constipation | 0 | AXR, CT scan | Flatus tube | 23 | Alive |
| 76 | Abdominal distension | Constipation | 1 | AXR, CT scan | Laparotomy for perforation | 145 | Died |
| 67 | Abdominal distension, Vomiting | Constipation | 2 | CT scan | Sigmoidoscopy, Flatus tube | 21 | Died |
| 87 | Abdominal distension, Vomiting | Constipation | 2 | AXR | Sigmoidoscopy, Flatus tube, phosphate enema | 3 | Died |
Conclusions: Our case series illustrates that sigmoid volvulus in PD carries a high burden of mortality, relapses and prolonged length of stay. Optimal management should include fluid resuscitation, correction of electrolyte imbalance, topical or parenteral dopamine agonist (as oral levodopa may not be absorbed) and surgical interventions including sigmoidoscopic decompression or elective surgery. Prompt and effective management of constipation reduces the incidence of relapses. References: 1. Drelichman ER, Nelson H. Colonic Volvulus. Current Surgical Therapy. 2004. 8th Edition. St. Louis (MO): C.V. Mosby. 2. Safioleas M, Ahatziconstantinou C, Felekouras E, et al. Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly: a study of 33 cases. World J Gastroenterol 2007; 13: 921-4.
To cite this abstract in AMA style:
K. Khalid, A. McColl, M. Gosney, A.K. Chatterjee. A case series of sigmoid volvulus in Parkinson’s disease [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/a-case-series-of-sigmoid-volvulus-in-parkinsons-disease/. Accessed November 22, 2024.« Back to 2016 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-series-of-sigmoid-volvulus-in-parkinsons-disease/