Ambiguous phenotypic states include a phallic structure that is intermediate between a clitoris and a penis, and a single perineal orifice that connects to both the urethra and the vagina (i.e. urogenital sinus). At birth, it may not be possible to immediately differentiate the external genitalia of individuals with PAIS as being either male or female, although the majority of individuals with PAIS are raised male. Given the wide diversity of phenotypes associated with PAIS, the diagnosis is often further specified by assessing genital masculinization. Grades 2 through 5 of the Quigley scale quantify four degrees of increasingly feminized genitalia that correspond to PAIS.Grade 2, the mildest form of PAIS, presents with a predominantly male phenotype that presents with minor signs of undermasculinized genitalia, such as isolated hypospadias, which can be severe. Hypospadias may manifest with a partially formed channel from the urethral opening to the glans. Until recently, it was thought that isolated micropenis was not a manifestation of PAIS. However, in 2010, two cases of PAIS manifesting with isolated micropenis were documented. Grade 3, the most common phenotypic form of PAIS, features a predominantly male phenotype that is more severely undermasculinized, and typically presents with micropenis and pseudovaginal perineoscrotal hypospadias with bifid scrotum.Grade 4 presents with a gender ambiguous phenotype, including a phallic structure that is intermediate between a clitoris and a penis. The urethra typically opens into a common channel with the vagina (i.e.
Sigmoid colon volvulus, also known as sigmoid volvulus, is volvulus affecting the sigmoid colon. It is a common cause of bowel obstruction and constipation. It is common in Asia, India (7% of intestinal obstruction) and especially South India because of the high fibre diet. It is a very common cause of large bowel obstruction in Peru and Bolivia due to high altitude. Signs and symptoms
Pain in abdomen – initially left-sided, eventually all over
Absolute constipation
Enormous distension of abdomen
Late vomiting and eventually dehydration
Features of peritonitis
Hiccup and retching may occur
Tyre-like feel of the abdomen is diagnostic

Cause
The condition is more common in males and with old age. It is also common in people with chronic constipation and laxative abuse. It is common in:
Ogilvie syndrome
Individuals with learning difficulties
Chagas disease
Hypothyroidism
Anticholinergic drugs
Multiple sclerosis
Scleroderma
Parkinsons diseaseIn sigmoid, volvulus rotation is always anticlockwise. It requires one and a half rotation to cause vascular obstruction and gangrene which eventually leads to perforation either at the root or at the summit of the sigmoid loop. Diagnosis
Plain X-ray (diagnostic in 70–80%): coffee bean sign is seen
Contrast enema: bird beak sign
CT scan: shows characteristic whirl pattern
Blood: haematocrit, renal functions, serum electrolytes

Treatment
RT aspiration
IV fluids
Catheterisation
Antibiotics
By flatus tube or sigmoidoscope, derotation is done
If derotation does not occur, then laparotomy through midline incision should be done. It is derotated manually. If viable, it can be fixed to lateral wall of abdomen or pelvis
If sigmoid colon is gangrenous, then Hartmanns operation or Paul Mikulicz operation is done

References


== External links ==