Objective: To evaluate management of constipation in acute sigmoid volvulus in Parkinson’s.

Background: Constipation is one of the main and disabling non motor symptoms in Parkinson’s with a prevalence ranging from 24.6% to 63%(1).Prompt management reduces the risk of complications such as volvulus and improves quality of life.

Method: Parkinson’s patient admitted with volvulus in year 2021/2022 were identified by medical informatics. Data was collected from Electronic Patient Record

Results: 10 (9 male) patients with average Parkinson’s duration of 6 years were admitted with acute volvulus. All presented with abdominal pain and distention and 4 had recurrence.5/10(50%) had preceding constipation and 6/10(60%) were on already on laxatives. Table 1 shows breakdown of laxatives use prior to volvulus.

In addition to endoscopic decompression, laxative dose was increased and regular enemas were added in 9/10 cases. All patients had TFTs done in the last 6 months. There was no written documentation of dietary advice on use of roughage during the acute admission or previous clinic reviews.

All recurrent presentations were discharged on enemas and 2 patients were referred to district nurses for enema administration.

Conclusion: Half of the patients with acute sigmoid volvulus had unresolved constipation on presentation with 60% already taking laxatives. Combination of osmotic and stimulant laxatives was the preferred choice in all cases prior to volvulus while after decompression enemas were continued. There is a need for patient education about laxative use, dietary advice and support from community nursing team to optimise constipation management.

References: 1-https://doi.org/10.1016/bs.irn.2017.06.003

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MDS Abstracts - https://www.mdsabstracts.org/abstract/management-of-constipation-in-parkinsons-patients-presenting-with-acute-sigmoid-volvulus-to-royal-berkshire-hospitalreading-uk/