Results of resection of the right colon for volvulus

Abstract

The aim of the present study was to evaluate retrospectively the results of resection for volvulus of the right colon. Over a 15-year period, 39 patients (29 women, i0 men, mean age: 63 years) were admitted with acute right colon volvulus. Preoperative diagnosis was obtained in 48% of the cases. A right hemicolectomy was performed in all the cases,'with primary anastomosis in 37 cases and double ilial and transverse stomy in 2 cases. Gangrene was observed in 20 patients (5 i %). Postoperative mortality was 7.7% (n = 3) due to septic shock and multi-organ failure in 2 tases, and respiratory failure in the other case. Postoperative morbidity was 21% (n = 8) including 2 cases of anastomotic leaks. On the basis of this study anda review of the literature, it appears that right hemicolectomy is the treatment of choice for volvulus of the right colon, as it avoids all risks of recurrente and mortality is lower than conservative treatment.

Volvulus of the Small Bowel and Colon

“…A primary anastomosis even in the setting of gangrene is acceptable; however, depending on the patient's nutritional status, comorbid conditions, or other factors negatively influencing healing, ileostomy creation may be preferred. 45 Several options have been described for treatment including detorsion alone, cecopexy, cecostomy placement, and resection usually in the form of a right hemicolectomy. Cecopexy involves suturing the right colon to the right paracolic gutter using sutures.…”

Cecal Volvulus

“…Etiology and predisposing factors for CV include chronic constipation, abdominal masses, late-term pregnancy, previous abdominal surgery, prolonged immobility, high-fiber intake, paralytic ileus, and colonoscopy [4,7,[9][10][11][12]. According to the clinical series published before, previous abdominal surgery was identified as an important contributing factor for formation of CV, based on the fact that 23-53 % of the patients presenting with CV have had a history of prior abdominal surgery [4,9].…”

“…Clinical presentation is highly variable, ranging from intermittent episodes of abdominal pain to abdominal catastrophe, depending on the pattern, severity, and duration of intestinal obstruction [1,4,9]. Abdominal pain associated with nausea, vomiting, and abdominal distension was reported as the most common symptom in CV patients [7,[10][11][12]. Patients with acute CV and obstruction present a clinical picture similar to small bowel obstruction.…”

“…In addition to resection, cecopexy by approximating the tinea of the remainder of the right colon to the peritoneum of the right paracolic gutter with permanent sutures was also recommended to prevent recurrences [3]. If the detorsed cecum is viable and there is no suspicion about its viability, there are several different procedures including operative detorsion via cecopexy and cecostomy [6,[10][11][12]. Operative detorsion without cecostomy or cecopexy should not be used anymore because of high risk of recurrence [1].…”

Volvulus of Caecum

“…Endoscopic deflation has little place but there is a chance of recurrence. The definitive treatment of cecal volvulus even when the bowel is viable is right hemicolectomy, as it avoids all risk of recurrence and mortality is lower than that obtained with conservative treatment 8,9 .…”