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DEAR DR. ROACH: This past weekend, during my son’s wedding festivities, I experienced a sigmoid volvulus. Doctors recommended surgery, but I opted for a colonoscopy, which was performed successfully. Thank goodness. I was immediately a new woman, and no one would have dreamed I went through this emergency. The surgeons recommended I have my sigmoid colon removed in order to decrease the risk of recurrence. Ideally, this would happen as soon as possible.
What could have prompted the sigmoid volvulus? Is it an absolute that I must have my sigmoid colon removed? What are the odds of it recurring? If I do need the surgery, how can I best prepare for it, and what are the side effects? – M.B.
ANSWER: A volvulus is the twisting of a hollow structure in the body around its long axis (imagine holding one end of a sock in each hand and flipping the middle so it twists on itself). The sigmoid colon is the most common location. It is a surgical emergency, as tissue death and gangrene may follow. The biggest risk factor for volvulus is chronic constipation, but some people just have anatomy that predisposes them to get a volvulus.
Surgery is the definitive treatment, but colonoscopy or sigmoidoscopy may be used to untwist the colon; medical professionals use the term “reduce.” However, your surgeon was right that you are at risk for this happening again. In those people with a history of volvulus, 50% to 60% will get another, and if you have two, the recurrence rate is even higher.
For a person in generally good health, I would recommend definitive surgery to prevent recurrence of volvulus. There are no specific instructions to prepare for surgery, beyond taking good care of yourself and following your surgeon’s instructions about your medications (if any). Any abdominal surgery has the risk of bleeding, infection and adhesions (connections between loops of bowel that can lead to painful obstruction later); however, these risks are quite small.
DEAR DR. ROACH: I’m a 71-year-old male who just underwent surgery for tongue cancer. It was diagnosed as an invasive squamous cell carcinoma with strong P16 staining consistent with human HPV. We’ve never been vaccinated for HPV. Is it advisable for my wife (66 years old) and me to be vaccinated with Gardasil 9? She was tested by her gynecologist and does not have HPV at this time. – R.L.
ANSWER: Human papillomavirus is an increasing cause of cancer in the head and neck, and it is believed that vaccination is likely to prevent most cases of this type of cancer, which mostly occur in men. Although there are clinical trials ongoing now to see whether vaccination may help treat existing HPV-related cancers, it is not routinely recommended for people with HPV-related cancers.
Your wife was wise to get tested for HPV. Given her age, she would not normally be considered a candidate for the vaccine. Odds are she has already been exposed to the virus during your marriage and has successfully resisted the infection. Some people in her situation might consider the vaccine, given its low risk of side effects, despite lack of proven effectiveness in this situation. However, it would be three doses of the vaccine, which would not normally be covered by insurance in the U.S.
Dr. Roach regrets he is unable to answer individual questions, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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