Tales from the bottom end: Part one

 

Ziggy and his floppy siggy 


I first met Ziggy after his fifth presentation to the Emergency Department for the same thing. He was elderly and suffered from chronic constipation. He was obstipated (no flatulence, no bowel movement) for a couple of days, and he had lower abdominal pain. His abdomen was massively distended. It looked like he had stolen a watermelon and hid it under his patient gown, but that was not the case.

 

Ziggy had a floppy and redundant sigmoid and mesentery that had twisted on itself at its fixed point the rectosigmoid junction. He had come in with recurrent sigmoid volvulus. He had an abdominal X-ray which showed all the textbook features – distended sigmoid “Coffee Bean” sign. If it wasn’t decompressed there was risk of ischemia, infarct, sepsis and mortality. In the first instance this required an attempt at decompression, and then later surgery to remove the redundant loop to prevent this from happening again.

 

I came with my resident to do this patients decompression with the rigid sigmoidoscope and rectal tube. The keen ED resident who referred me this patient also wanted to see, as he had not seen one before. Ziggy didn’t care.  See one, do one, teach one. We were in the smallest cubicle in the department across from EOU; it was the size of a shoebox, and the rest of the department was full. You only needed to take three steps to get from one wall to another, it barely fit the patient trolley and a chair.

 

We set up and performed the procedure. Five pairs of gloves, a visor, blueys everywhere. We had enough Personal Protective Equipment for a Bombsquad job. My resident began, and I took over just before the point of volvulus. We found the lumen and advanced further. Then, came the noise. The pressure popped open the little vision port of the rigid tube, and a fountain of liquid faeces catapulted across the room. Graffiti on the wall, marking our arrival. I was lucky to be out of the line of fire in time. Our ED observer standing in the corner of the room unfortunately wasn’t so lucky.

 

We inserted a rectal tube to maintain patency, his symptoms subsided almost immediately, he ended up having a sigmoidectomy with primary anastomosis and made a full recovery.

 

The other day, on my day off, I drove past a place called “Ziggy’s Café”, I kept going. It reminded me of the stains on that wall that day, and the coffee served by old mate Ziggy.

 

Dr. Chris Ip

Disclaimers:

This is a real case. The events are true and what happened was genuine. Radiographs – taken with permission from patient – verbal consent; these have been deidentified and are anonymous.  

Ziggy is a pseudonym and not the formal or proper name of patient.

Ziggy’s Café does really exist, and is located near Mildura.

 
Figure 1:   Sigmoid volvulus, The inverted U or “Omega Loop” or “Coffee bean sign”

Figure 1: Sigmoid volvulus, The inverted U or “Omega Loop” or “Coffee bean sign”

Figure 2 : Post decompression and insertion of rectal tube of same patient.

Figure 2: Post decompression and insertion of rectal tube of same patient.