Cecal volvulus: outcome of management by celiotomy

Grossmann, Erik M.; Johnson, Frank E.; Enger, K.T.; Leake, Brett; Virgo, Katherine S.; Longo, Walter E.

doi:10.1007/s101510050034

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…Therefore, identifying those patients at the onset of their clinical course entails a high index of suspicion. 17 In our series , patients C/O nearly from the same i.e. pain was the leading complaint, then abdominal distention and constipation also leucocytosis was a prominent feature in our patients.…”

Section: Discussionsupporting

confidence: 55%

Management of colonic volvulus

Kamal

Saad

2011

Ain Shams Journal of Surgery

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Aim: Colonic volvulus is defined as an axial twist of part of the colon along its mesentery of which sigmoid volvulus is the most common & splenic flexure volvulus is the least common. The purpose of this study is to evaluate the clinical features and surgical treatment methods in patients with colonic volvulus.Method : Thirty-six patients operated upon between April 2007 and Mars 2010 were reviewed retrospectively. The demographic data of the patients, clinical features, preoperative radiological and operative findings, type of surgical procedure performed, postoperative complications, mortality and duration of hospital stay after surgery were reviewed.Results : There were 26 male (72%), 10 female patients (28%) and their age ranged from 28 to 72 years with a mean of 53±7.8 years. Most frequent clinical features were abdominal pain, distension and constipation by order of frequency. Hypertension was the most frequent co-morbidity. WBCs were elevated in 32 patients. Plain X-ray was done routinely in every patient with +ve results in 28 patients (77%) & contrast enema was done in 6 patients only. Emergent surgical treatment done in patients with manifestations of peritonitis (30pt, 83%). Intra-operative, sigmoid volvulus was found in 30 pts, caecal volvulus in 3 patients, transverse colon volvulus in 2 pts and one case of splenic flexure volvulus. Decision for operation (Untwisting & fixation (n=3), resection & primary anastomosis (n=10), resection, anastomosis & covering stoma(n=11) and resection & colostomy (n=12), was dependent on intestinal viability, general condition of patient and surgeon's preference. Post operative hospital stay ranged from 5 days to 26 days. It was least in patients underwent resection, anastomosis & covering stoma 8±4.11 and maximum in patient with just detortion & fixation (15±8.53). Post operative complications included post-operative, anastomotic leakage, wound infection, re-operation (Recurrent obstruction) and pulmonary complications. Conclusion : Identifying those patients at the onset of their clinical course of colonic volvulus entails a high index of suspicion & resection with or without primary anastomosis should be the basic principle in management of colonic volvulus as detorsion and fixation carry a high risk of recurrence of the volvulus

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Section: Discussionsupporting

confidence: 55%

Management of colonic volvulus

Kamal

Saad

2011

Ain Shams Journal of Surgery

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“…Prior reports have described higher mortality rates when gangrene is present [ 9 , 10 ]. The emergent nature of the operations in this series likely increases the mortality when compared to other reports [ 11 , 12 ] as all patients who experienced mortality were perforated at the time of operation. Compared to other causes of intestinal obstruction and volvulus at our institution, cecal volvulus carries a higher risk of mortality.…”

Section: Discussionmentioning

confidence: 80%

Cecal volvulus in rural Kenya: delayed presentation contributes to high mortality

Sylvester

Ooko²,

Mwachiro

et al. 2021

BMC Surg

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Background Cecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. It is a rare reported cause of adult intestinal obstruction. This study aimed to review the clinical presentation, management, and outcomes at a rural, resource-limited referral center. Methods We performed a retrospective review of all patients with a diagnosis of cecal volvulus between January 1st, 2009 and December 31st, 2019 at Tenwek Hospital in Bomet, Kenya. The outcome of survival was compared by the time to presentation. Mortality was also compared with prior reports of intestinal obstruction at our institution. Results Thirteen patients were identified with a mean age of 52 years and a mean symptom duration of 5 days. All patients presented with abdominal pain and distension. Seven patients (54%) presented with perforation, gangrene, or gross peritoneal contamination. Identified risk factors were Ladds bands with malrotation, adhesions, and a sigmoid tumor. Procedures included primary resection and anastomosis (7), damage control (3) with anastomosis on second-look in 2 of these, simple surgical detorsion (1), and surgical detorsion and cecopexy (2). There were four mortalities (31%), of which all had delayed presentation with perforation and fecal contamination. Delays to presentation were associated with mortality (p = 0.03). Cecal volvulus resulted in increased perioperative mortality compared to all intestinal obstructions presenting to the institution (p < 0.0001). Conclusions Cecal volvulus carries a high risk of mortality. A high index of suspicion and early consideration in the differential diagnosis of intestinal obstruction should be considered to reduce the mortality associated with the delay in preoperative diagnosis.

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“…1 If there is intestinal gangrene, resection is inevitable, as was in our patient. In non-gangrenous cases, it is sufficient to simply untwist the Caecum or additionally to perform a Caecopexy by fixing it to the abdominal wall 1,3 , Caecopexy provides a safe alternative to resection and primary anastomosis in suitably selective patients 10 , and laparoscopic technique is preferred perioperative mortality of Caecal volvulus is approximately 0-40% depending on the bowel viability or gangrene, as well as the type of the therapeutic procedure. 1,3 Early diagnosis is essential in order to reduce the high mortality rate.…”

Section: 3mentioning

confidence: 99%