Emergency one-stage resection without mechanical bowel preparation for acute sigmoid volvulus

Oludiran, OO; Osime, OC

doi:10.4314/jmbr.v3i1.10662

Cited by 3 publications

(7 citation statements)

References 10 publications

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“…The most common colonic volvulus is in the sigmoid colon [ 8 ]. It often occurs in the elderly or in psychiatric patients, and accounts for approximately 8% of all intestinal obstructions [ 9 ]. The initial treatment is sigmoidoscopy with decompression and detorsion [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Ischemic volvulus of the transverse colon: A case report and review of literature

et al. 2008

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A 75-year old male presented to the emergency room with worsening abdominal pain and distension. Plain radiographs were suggestive of a large bowel obstruction due to volvulus. An attempt to detorse the volvulus and decompress the colon endoscopically failed, after which the patient was taken for an exploratory laparotomy. A transverse colon volvulus was found, and an extended right hemicolectomy and ileostomy was performed. We discuss the diagnosis and management of transverse colon volvulus and review the pertinent literature. Case presentationA 75-year old Caucasian male presented to the emergency department with severe abdominal distension and mild dyspnea. A retired auto factory worker, he was 5 feet 9 inches tall and 250 pounds. His medical history was significant for diabetes mellitus, coronary artery disease, and a myocardial infarction. He had undergone bilateral inguinal hernia repairs. Medications included metoprolol, aspirin, enalapril, and metformin. The patient was reformed smoker, and drank alcohol occasionally. His family history was significant for diabetes. The patient also admitted with a history of chronic constipation for which he often self-medicated with magnesium citrate. Prior to presentation his efforts had been unsuccessful, and he had not had a bowel movement for ten days.Physical examination revealed a thin elderly gentleman with a massively distended abdomen; it was tympanic to percussion with minimal bowel sounds and visibly dilated loops of bowel. The abdomen was non-tender and there were no signs of peritonitis. Digital rectal examination revealed an empty rectal vault and no intraluminal masses.Laboratory studies demonstrated leukocytosis, hypokalemia, and prerenal azotemia. Abdominal radiographs were obtained and showed massively distended large bowel, and was suggestive of obstruction due to volvulus ( Figure 1). Both hemidiaphragms were elevated because of the dilated large bowel, which likely explained the patient's dyspnea (Figure 2).Due to the massive distension, we decided against performing a barium enema. Instead, we elected to attempt endoscopic decompression and detorsion. This was preformed in the operating room to allow for the possibility of failure with conversion to laparotomy. We were unable to advance the endoscope beyond the splenic flexure. The

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Section: Discussionmentioning

confidence: 99%

Ischemic volvulus of the transverse colon: A case report and review of literature

et al. 2008

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“…The overall mortality of SV, which was originally more than 50%, has now dropped well below 10% [1,2,71,125–141,152,170]. Bhatnagar et al.…”

Section: Outcome and Prognostic Factorsmentioning

confidence: 99%

“…Ethical issues did not arise as ERPA was the only practical option in such compromised settings. Nonrandomized series reported by these surgeons now provide overwhelming level-4 evidence for the safety of ERPA in SV [128][129][130][131][132][133][134][135][136][137][138][139][140][141]. Hence, RCTs can be designed hereafter without the fear of ethical violation.…”

Section: Box 3 Clinical Indicators Of Ischaemic Bowel In Sigmoid Volvmentioning

confidence: 99%

“…The overall mortality of SV, which was originally more than 50%, has now dropped well below 10% [1,2,71,[125][126][127][128][129][130][131][132][133][134][135][136][137][138][139][140][141]152,170]. Bhatnagar et al [171] identified 1980 as the watershed year.…”

Section: Outcome and Prognostic Factorsmentioning

confidence: 99%

“…The same authors who reported low mortality of SV with on‐table lavage subsequently published equally good results without it [127,128]. Currently, the mortality of ERPA without on‐table lavage is < 5% [125,129,130] although a few series have claimed zero mortality [72,75,76,128,131,132]. Safety of ERPA in gangrenous SV is also documented [75,125].…”

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confidence: 99%

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Volvulus of the sigmoid colon

et al. 2010

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Is single-stage resection and anastomosis for acute sigmoid volvulus, without intra operative colonic lavage a safe procedure?

Bilal

Aslam

Jan

et al. 2021

TPMJ

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Objective. This study was conducted to provide local data regarding the results and post-operative complications after single-stage resection and anastomosis for acute sigmoid volvulus, without intra operative colonic lavage. Study Design: Descriptive Cross Sectional. Setting: DHQ Charsadda. Period: May 2017 to December 2019. Material & Methods: This clinical study was done on 50 patients who presented with the signs and symptoms of acute sigmoid volvulus excluding those with complications of the illness such as gangrene, perforation and peritonitis. Surgery for all patients was carried out under General anaesthesia. All the patients underwent emergency resection and primary anastomosis, without mechanical bowel preparation. Data were collected regarding post operation complication and analysis by using SPSS version 23. Chi square test was used to compare at level of significance <0.005. Results: Median age of patients was 50 years with male to female ratio 5:3. Seven patients presented with wound infection, one dehiscence while zero Anastomotic leakage and zero death postoperative recorded. Conclusion: Single stage resection and primary anastomosis without preoperative colonic lavage for acute sigmoid volvulus is a simpler and short procedure with low mortality and morbidity rates.

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Emergency one-stage resection without mechanical bowel preparation for acute sigmoid volvulus

Cited by 3 publications

References 10 publications

Ischemic volvulus of the transverse colon: A case report and review of literature

Ischemic volvulus of the transverse colon: A case report and review of literature

Volvulus of the sigmoid colon

Is single-stage resection and anastomosis for acute sigmoid volvulus, without intra operative colonic lavage a safe procedure?

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