Experience with colonic volvulus

Abstract

Fifty-eight cases of colonic volvulus were reviewed including 30 cases of sigmoid volvulus, 27 cases of cecal volvulus, and 1 of transverse colon volvulus. Decompression procedures were attempted in 31 instances of sigmoid volvulus in 27 patients and were successful 25 times (81 percent). Seven patients with sigmoid volvulus did not undergo surgery and of those, two died of unrelated causes, one was lost to follow-up, one was well, and three had recurrent volvulus. Twenty-four operations were performed on 23 patients and there were three deaths (13 percent mortality). There was one recurrence in two patients who underwent simple detorsion. Chronic large-bowel motility disturbances were a persistent problem in 9 of 20 (45 percent) surgical survivors. Among 27 instances of cecal volvulus, one was reduced by contrast enema and ten endoscopic attempts at decompression were unsuccessful. Twenty-six operations were done and there were four operative deaths (15 percent mortality). There were no recurrences. Large-bowel motility disorders were noted in follow-up in 3 of 22 patients (14 percent). Overall there were 10 deaths in 58 patients for a 17 percent mortality rate. These data support the importance of endoscopic decompression for sigmoid volvulus but not for cecal volvulus. Definitive treatment of both forms of volvulus should include assessment of colonic motility.

Laparoscopy-Assisted PEC Tubes: A Novel Treatment for Sigmoid Volvulus

“…Use of the laparoscope was unusual, despite observations that instrumental perforation is a complication in more than 1% of endoscopic decompression cases. [15][16][17][18][19] Not only could the laparoscope reduce risk of complication during the decompression phase, its presence during PEC placement (combined with the endoscope) allowed for more informed movements both inside and outside of the bowel. The primary question is therefore whether the increased frequency of laparoscopy-related complications and complications associated with general anesthesia will outweigh the reduction in complications by affording better visualization and instrument control, a question that can only be answered in a much broader study.…”

Síndrome de Chilaiditi associada a volvo de cólon sigmóide: relato de caso

“…Falhando a descompressão endoscópica ou havendo sinais de isquemia intestinal, a ressecção do segmento comprometido se impõe (procedimento de Hartman para urgência e não preparo colônico é a técnica cirúrgica mais utilizada). (14) Embora a síndrome de Chilaiditi possa ser tratada de forma conservadora, com repouso no leito, descompressão nasogástrica, dieta líquida e enemas, o procedimento cirúrgico deve ser considerado, quando os sintomas não respondem à terapia conservadora ou há sinais de complicação. (15,16) …”

Endoscopic Fixation of Rectal Decompression Tube for Sigmoid Volvulus

“…2,3 Traditionally, a rectal tube is placed with the aid of a rigid sigmoidoscope to achieve decompression of the sigmoid volvulus and reduce short-term recurrence. Flexible sigmoidoscopy may be a safer technique to achieve decompression, and also allows direct visualisation of the mucosa to exclude ischaemia.…”

“…[1][2][3] This report describes a straightforward method for paediatric umbilical hernioplasty that we feel enables a good repair and achieves an acceptable cosmetic outcome.…”