Recurrent sigmoid volvulus treated by percutaneous endoscopic colostomy

Daniels, Ian R.; Lamparelli, M. J.; Chave, Helen; Simson, J. N. L.

doi:10.1046/j.1365-2168.2000.01537.x

Cited by 43 publications

(47 citation statements)

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“…Complications in this series were similar to those encountered previously 3,4 and included site infection, bleeding, buried bumper syndrome, faecal urgency and pain. The most serious complication was early tube migration resulting in peritonitis, which proved fatal in one patient.…”

Section: Discussionsupporting

confidence: 59%

“…Sigmoid volvulus recurred in one of the present patients when infection necessitated the removal of one of two tubes. Daniels and colleagues 3 found that early removal of colostomy tubes resulted in recurrence in three of eight patients. This is presumably because, without the second tube, the sigmoidopexy fails if the sigmoid colon is not fibrotically adherent to the abdominal wall.…”

Section: Discussionmentioning

confidence: 97%

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Prospective analysis of percutaneous endoscopic colostomy at a tertiary referral centre

Baraza

Brown

McAlindon

et al. 2007

British Journal of Surgery

101

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 97%

Prospective analysis of percutaneous endoscopic colostomy at a tertiary referral centre

Baraza

Brown

McAlindon

et al. 2007

British Journal of Surgery

101

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“…1-2 The use of PEC has been reported in this patient population as a way of reducing the need for major abdominal surgery. [3][4][5] In contrast, sigmoid volvulus is the commonest cause of large bowel obstruction in Africa, accounting for up to 50% of cases in countries such as Ethiopia. 6 It is also a major cause of colonic obstruction in Asia and South America.…”

Section: Discussionmentioning

confidence: 91%

“…This has been reported to occur within 6 weeks of PEC insertion. 4 However, recurrence has been described on removal of PEC tubes 7 months after placement. 11 In contrast, Baraza et al report no recurrence in 6 patients who underwent tube removal between 5 and 26 months.…”

Section: Discussionmentioning

confidence: 99%

Volvulus of the Sigmoid Colon Treated by Percutaneous Endoscopic Colostomy

Mullen¹,

Church

Yalamarthi³

2009

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Volvulus of the sigmoid colon is a condition that, in the Western world, predominately affects the elderly. In fit patients sigmoid colectomy, after a period of decompression, is the treatment of choice. However, this carries a high mortality in elderly high-risk patients. Percutaneous endoscopic colostomy (PEC) has been reported as a treatment for those who are considered high risk for surgery. We report the successful use of PEC in an 87-year-old lady, for the treatment of recurrent sigmoid volvulus, without complication. This procedure has also been used effectively for colonic pseudo-obstruction, constipation, and obstructed defecation. There are various complications associated with PEC, the most serious of which is tube migration and fecal peritonitis. Our experience supports the use of PEC to treat sigmoid volvulus in those too frail for colonic resection.

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“…Promising results have been described for percutaneous endoscopic colostomy in selected patients, although the technique is not wide-spread and has not been employed in our unit. 24 The overall mortality rate for operatively managed patients in our series was 6% (1 of 15). Surgery may be considered a definitive treatment as no patient was subsequently admitted for acute volvulus.…”

Section: Discussionmentioning

confidence: 94%

Recurrent Sigmoid Volvulus – Early Resection may Obviate Later Emergency Surgery and Reduce Morbidity and Mortality

Larkin

Thekiso

Waldron

et al. 2009

annals

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Acute sigmoid volvulus is commonest in the Western world among the elderly and the institutionalised. Given the significant co-morbidity in this population and the perceived risks associated with definitive surgery, many surgeons elect to manage this condition conservatively with colonoscopic decompression alone. Non-operative management of acute sigmoid volvulus potentially obviates surgical morbidity in high-risk elderly and frail patients with distended, unprepared bowel. However, because recurrence rates (55-90%) and mortality rates (40%) are high, conservative treatment should be used predominantly to move patients from emergency surgery status to semi-elective surgery status.1-8 Indeed, following initial resuscitation of patients with acute sigmoid volvulus, including an attempt to detort the volvulus colonoscopically where appropriate, definitive surgery may prevent the significant morbidity and mortality associated with subsequent episodes of volvulus. We reviewed our unit's experience with non-operative and operative management of this condition. Patients and MethodsThe records of all patients who underwent emergency nonoperative or operative treatment for acute sigmoid volvulus in the Department of Surgery, Mayo General Hospital, during an 11-year period between January 1996 and December 2006, were reviewed retrospectively. The age, gender, co-morbid problems, ASA score, clinical presentation, indication, nonoperative or operative procedures, mortality, morbidity, hospitalisation period, and recurrence rates were considered.Patients were identified from the operating theatre register and admissions office records. PATIENTS AND METHODS We reviewed our unit's experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mor...

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Recurrent sigmoid volvulus treated by percutaneous endoscopic colostomy

Cited by 43 publications

References 1 publication

Prospective analysis of percutaneous endoscopic colostomy at a tertiary referral centre

Prospective analysis of percutaneous endoscopic colostomy at a tertiary referral centre

Volvulus of the Sigmoid Colon Treated by Percutaneous Endoscopic Colostomy

Recurrent Sigmoid Volvulus – Early Resection may Obviate Later Emergency Surgery and Reduce Morbidity and Mortality

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