Gut Pain Not to Be Ignored

May 21, 2020

In October 2019, everything was going smoothly health-wise for 66-year-old Joe Palazzolo. He was enjoying a trimmer weight, having lost and kept off 100 pounds after bariatric surgery at Bayshore Medical Center in 2016, and was bothered only by a little arthritis in his knees.

All of that came to an abrupt halt when he began experiencing painful spasms in his lower abdomen one Friday. “At first, I thought it was gas or a hernia,” Joe says. “The weird thing was the spasms would last seven or eight seconds and then stop, but they would come back every five or six minutes. I actually timed them with my watch.”

Joe suffered through this recurrent pain around the clock over the course of the weekend. Finally, on Monday, October 21, Joe’s wife insisted that he go to the Emergency Care Center at Bayshore. The team there began a battery of tests, including a sonogram and CT scan, and called in surgeon Hung Q. Nguyen, M.D., to consult.

The doctors arrived at a diagnosis of sigmoid volvulus—a condition in which the sigmoid colon twists on itself, causing bowel obstruction and dangerously restricted blood flow in the affected structure. (The sigmoid colon is the last section of the colon, connected to the rectum.) “Imagine a balloon that has been twisted,” Dr. Nguyen says. “Nothing can move from one section to the other. Plus the tissue of the sigmoid is starved of blood.” The condition can be fatal if not treated in a timely fashion.

A Minimally Invasive Solution

Joe was admitted to the hospital Monday and given pain medication so he could rest. Testing continued on Tuesday, and Dr. Nguyen scheduled him for surgery for the next day. “It requires surgery to untwist a volvulus and correct the underlying mechanism,” says Dr. Nguyen, who used the da Vinci surgical robot to operate on Joe. This minimally invasive approach was the first time the da Vinci had been used to treat sigmoid volvulus at Bayshore. “During the surgery, 2 feet of the redundant colon was removed and the two good ends were rejoined,” Dr. Nguyen adds.

This condition is more common in older adults but fairly rare. One factor that contributed to Joe developing the problem was an extremely long sigmoid colon—much longer than the average person’s, which measures about 14 to 16 inches. Joe had heard that his sigmoid colon was extra long when he went to his gastroenterologist, Marc Wolfman, M.D., for a screening colonoscopy earlier in the year. Dr. Wolfman told Joe that he couldn’t complete the colonoscopy because the scope wasn’t long enough to reach all the way through the colon.

Dr. Nguyen draws an analogy of the elongated colon to an out-stretched rubber band where it is no longer able to return to the usual length. “Chronic constipation is thought to predispose the colon to progressive dilation and lengthening and eventual as the mechanism for volvulus,” Dr. Nguyen says.

Joe appreciates Dr. Nguyen’s skill and the robotic approach. “I have five or six ¼-inch marks from the surgery,” he says. “They just dabbed a little glue on them—there aren’t any stitch marks at all.” He stayed in the hospital until Saturday, then went home with no dietary restrictions. “I was anxious to get back home to spend Halloween with my granddaughters. They brought home a pretty good candy haul.”

Joe was back at work just nine days after he first went into the hospital, and Dr. Nguyen is pleased with his recovery. “I feel good,” Joe says. “My doctors tell me I just have to eat a little more fiber.”

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