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Ortega EM, Ruano DDJR, Al‐Zoubi RM, Alansari AN. Transverse colon volvulus: A case report of an uncommon cause of acute abdomen in pediatrics. Clin Case Rep 2024; 12:e8828. [PMID: 38736570 PMCID: PMC11087218 DOI: 10.1002/ccr3.8828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Transverse colonic volvulus (TCV) is a serious condition with a mortality rate of up to 33%. It is very rare, especially in children. Despite its rarity, surgeons should have a high index of suspicion and include it in the list of differential diagnoses, especially in patients with developmental delays and associated uncommon syndromes. Resection and anastomosis, whether as a one-stage or two-stage procedure, proved to be the best treatment options for children. Since prompt identification and management are vital, this paper presents useful information on the presentation, treatment, and outcome of this case report.
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Affiliation(s)
- Evenildo Martinez Ortega
- Department of Pediatric SurgeryJuan M Marquez Children's HospitalHavanaCuba
- Department of Pediatric SurgeryHamad Medical CorporationDohaQatar
| | - Dollis De Jesús Rodríguez Ruano
- Department of Pediatric SurgeryJuan M Marquez Children's HospitalHavanaCuba
- Department of Pediatric SurgeryHamad Medical CorporationDohaQatar
| | - Raed M. Al‐Zoubi
- Surgical Research Section, Department of SurgeryHamad Medical CorporationDohaQatar
- Department of Biomedical Sciences, QU‐Health, College of Health SciencesQatar UniversityDohaQatar
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Rafaqat W, Lagazzi E, McChesney S, Smith MC, UrRahman M, Lee H, DeWane MP, Khan A. To Resect or Not to Resect: A Nationwide Comparison of Management of Sigmoid Volvulus. J Surg Res 2024; 297:101-108. [PMID: 38484451 DOI: 10.1016/j.jss.2023.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/29/2023] [Accepted: 12/24/2023] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Despite the high recurrence rate of sigmoid volvulus, there is reluctance to perform a prophylactic colectomy in frail patients due to the operation's perceived risks. We used a nationally representative database to compare risk of recurrence in patients undergoing a prophylactic colectomy versus endoscopic detorsion alone. METHODS We performed a retrospective cohort study using the National Readmission Database (2016-2019) including patients aged ≥18 y who had an emergent admission for sigmoid volvulus and underwent endoscopic detorsion on the day of admission. We performed a 1:1 propensity matching adjusting for patient demographics, frailty score comprising of 109 components, and hospital characteristics. Our primary outcome was readmission due to colonic volvulus and secondary outcomes included mortality, complications, length of stay (LOS), and costs during index admission and readmission. We performed a subgroup analysis in patients with Hospital Frailty Score >5. RESULTS We included 2113 patients of which 1046 patients (49.5%) underwent a colectomy during the initial admission. In the matched population of 830 pairs, readmission due to colonic volvulus was significantly lower in patients undergoing endoscopy followed by colectomy than endoscopy alone. Patients undergoing a colectomy had higher gastric and renal complications, longer LOS, and higher costs but no difference in mortality. In the subgroup analysis of frail patients, readmission was significantly lower in patients with prophylactic colectomy with no significant difference in mortality in 439 matched patients. CONCLUSIONS Prophylactic colectomy was associated with lower readmission, a higher rate of complications, increased LOS, and higher costs compared to sigmoid decompression alone.
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Affiliation(s)
- Wardah Rafaqat
- Division of Trauma, Emergency General Surgery, and Surgical Critical care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emanuele Lagazzi
- Division of Trauma, Emergency General Surgery, and Surgical Critical care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shannon McChesney
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael C Smith
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mujeeb UrRahman
- Department of Surgery, District Headquarters Hospital, Buner, Pakistan
| | - Hanjoo Lee
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Michael P DeWane
- Division of Trauma, Emergency General Surgery, and Surgical Critical care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aimal Khan
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
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Tian BWCA, Vigutto G, Tan E, van Goor H, Bendinelli C, Abu-Zidan F, Ivatury R, Sakakushev B, Di Carlo I, Sganga G, Maier RV, Coimbra R, Leppäniemi A, Litvin A, Damaskos D, Broek RT, Biffl W, Di Saverio S, De Simone B, Ceresoli M, Picetti E, Galante J, Tebala GD, Beka SG, Bonavina L, Cui Y, Khan J, Cicuttin E, Amico F, Kenji I, Hecker A, Ansaloni L, Sartelli M, Moore EE, Kluger Y, Testini M, Weber D, Agnoletti V, Angelis ND, Coccolini F, Sall I, Catena F. WSES consensus guidelines on sigmoid volvulus management. World J Emerg Surg 2023; 18:34. [PMID: 37189134 DOI: 10.1186/s13017-023-00502-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
Sigmoid volvulus is a common surgical emergency, especially in elderly patients. Patients can present with a wide range of clinical states: from asymptomatic, to frank peritonitis secondary to colonic perforation. These patients generally need urgent treatment, be it endoscopic decompression of the colon or an upfront colectomy. The World Society of Emergency Surgery united a worldwide group of international experts to review the current evidence and propose a consensus guidelines on the management of sigmoid volvulus.
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Affiliation(s)
- Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Gabriele Vigutto
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cino Bendinelli
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Rao Ivatury
- Professor Emeritus Virginia Commonwealth University, Richmond, VA, USA
| | - Boris Sakakushev
- Research Institute at Medical University Plovdiv, University Hospital St George, Plovdiv, Bulgaria
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Ronald V Maier
- Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Raul Coimbra
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UCSD Health System - Hillcrest Campus, San Diego, CA, USA
| | - Ari Leppäniemi
- Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Andrey Litvin
- Department of Surgery, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Dimitrios Damaskos
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Richard Ten Broek
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Walter Biffl
- Queen's Medical Center, University of Hawaii, Honolulu, HI, USA
| | - Salomone Di Saverio
- Trauma and General Surgeon Royal Perth Hospital, The University of Western Australia, Perth, Australia
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Marco Ceresoli
- Emergency and General Surgery Department, University of Milan-Bicocca, Milan, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Joseph Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | - Giovanni D Tebala
- Department of Digestive and Emergency Surgery, S. Maria Hospital Trust, Terni, Italy
| | - Solomon Gurmu Beka
- School of Medicine and Health Science, University of Otago, Wellington Campus, Wellington, New Zealand
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Yunfeng Cui
- Department of Surgery, Nankai Clinical School of Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, University of Portsmouth, Southwick Hill Road, Cosham, Portsmouth, UK
| | - Enrico Cicuttin
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Francesco Amico
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Inaba Kenji
- Division of Trauma, Critical Care University of Southern California, Los Angeles, USA
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Luca Ansaloni
- General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Ernest E Moore
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Mario Testini
- Academic Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Nicola De' Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris, France
| | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal.
| | - Fausto Catena
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
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Simões G, Coelho da Rocha M, Capela T, Silva MJ, Ramos G, Coimbra J. Response Regarding: Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance? GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:376-377. [PMID: 34604474 DOI: 10.1159/000516649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Guilherme Simões
- Gastroenterology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Manuel Coelho da Rocha
- Gastroenterology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Tiago Capela
- Gastroenterology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Mário Jorge Silva
- Gastroenterology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Gonçalo Ramos
- Gastroenterology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - João Coimbra
- Gastroenterology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis 2021; 23:476-547. [PMID: 33470518 PMCID: PMC9291558 DOI: 10.1111/codi.15503] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
AIM There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.
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Affiliation(s)
- Andrew S. Miller
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Benjamin Box
- Northumbria Healthcare Foundation NHS TrustNorth ShieldsUK
| | | | - Sarah E. Duff
- Manchester University NHS Foundation TrustManchesterUK
| | | | | | | | | | | | | | - Phil J. Tozer
- St Mark’s Hospital and Imperial College LondonHarrowUK
| | - Danette Wright
- Western Sydney Local Health DistrictSydneyNew South WalesAustralia
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Kim EM, Kang BM, Kim BC, Kim JY, Park JH, Oh BY, Kim JW. Clinical outcomes of sigmoid volvulus and risk factors for its recurrence: a multicenter study in Korea. Int J Colorectal Dis 2020; 35:1841-1847. [PMID: 32072227 DOI: 10.1007/s00384-020-03526-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Sigmoid volvulus is one of the leading causes of colonic obstruction. The aims of this study were to review the treatment characteristics and clinical outcomes of patients diagnosed with sigmoid volvulus over 10 years at five university-affiliated hospitals in Korea, and to identify possible risk factors for its recurrence. METHODS Retrospective review was performed for medical records of patients who were diagnosed with sigmoid volvulus and managed surgically or conservatively at the five Hallym University-affiliated hospitals between January 2005 and July 2018. RESULTS A total of 69 patients were diagnosed, of whom 11 patients underwent emergency surgery and 58 patients were conservatively managed. Non-operative management was successful in 53 of 58 patients (91.4%) at initial admission. Of the non-operative managed patients, six patients required emergency surgery due to unsuccessful decompression or recurrence whereas 23 patients underwent regular surgery for definitive treatment. And overall recurrence rate and mortality rate were 25.8% (15/58) and 1.7% (1/58), respectively. A total of 40 patients underwent surgery; 23 underwent regular surgery and 17 underwent emergency surgery. Restoration of bowel continuity was more frequently performed in the regular surgery group than in the emergency surgery group (87.0% vs 52.9%, P = 0.03). In multivariable analysis, only non-operative management at the initial admission (P = 0.029) was independently associated with recurrence. CONCLUSION Although non-operative treatment can be initially attempted, surgery is required for preventing recurrence. Regular surgery should be considered to restore continuity of the bowel.
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Affiliation(s)
- Eui Myung Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Sukwoo-Dong, Hwaseong-Si, Gyeonggi-Do, 445-170, Republic of Korea
| | - Byung Mo Kang
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon- Si, 200-950, Republic of Korea
| | - Byung Chun Kim
- Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, 1, Shingil-ro, Yeongdeungpo-gu, Seoul, 150-950, Republic of Korea
| | - Jeong Yeon Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Sukwoo-Dong, Hwaseong-Si, Gyeonggi-Do, 445-170, Republic of Korea
| | - Jun Ho Park
- Department of Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 445 Gil-1-dong, Gangdong-gu, Seoul, 134-701, Republic of Korea
| | - Bo Young Oh
- Department of Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang-Si, 445-907, Republic of Korea
| | - Jong Wan Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Sukwoo-Dong, Hwaseong-Si, Gyeonggi-Do, 445-170, Republic of Korea.
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7
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da Rocha MC, Capela T, Silva MJ, Ramos G, Coimbra J. Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance? GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:160-165. [PMID: 32509921 DOI: 10.1159/000504721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/27/2019] [Indexed: 12/24/2022]
Abstract
Background Colonic volvulus, mainly from the sigmoid, is a relatively common cause of intestinal obstruction, particularly in the elderly and in patients with debilitating conditions. The high morbi-mortality of emergency surgery places the endoscopic approach as the first-line treatment for the resolution of this acute obstructive condition. Objectives To assess the importance of endoscopic treatment for the resolution of colonic volvulus in a debilitated population. Method This is a retrospective analysis of emergency lower gastrointestinal endoscopies in patients with colonic volvulus as diagnosis, performed over a 9-year period (2009-2018), as well as population characterization and follow-up after the first exam. Results We performed 88 procedures in 52 patients (56.4% males, median age 83 years, range 33-94). Endoscopic resolution was effective in 86.4% (76/88) of the exams, without procedure complications. Eighty-one percent of patients presented with volvulus recurrence, 50% of which occurred during the 3 months after the initial procedure. Twenty-one were submitted to surgery, 12 of which were emergency procedures after endoscopic failure as the primary treatment (5 of which had mucosal necrosis at endoscopy). There was no mortality in elective surgery. In the emergency plus necrosis group, mortality was 60% (3/5) and 14.3% (1/7) in the emergency without necrosis group. Conclusions Despite the high recurrence of volvulus after endoscopic treatment, it seems to be an adequate and low-risk first-line therapy for sigmoid volvulus in debilitated patients, allowing improvement of surgical conditions.
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Affiliation(s)
- Manuel Coelho da Rocha
- Gastroenterology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Tiago Capela
- Gastroenterology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Mário Jorge Silva
- Gastroenterology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Gonçalo Ramos
- Gastroenterology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - João Coimbra
- Gastroenterology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Gonzalez-Urquijo M, Rodarte-Shade M, Gil-Galindo G. Acute Colonic Volvulus in a Mexican Population: A Case Series. Ann Coloproctol 2020; 36:48-53. [PMID: 32079051 PMCID: PMC7069679 DOI: 10.3393/ac.2019.01.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/02/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose Colonic volvulus constitutes a significant cause of large bowel obstruction in adults. Most studies of colonic volvulus come from high endemic zones and are limited by the small number of patients. In our region, there is a shortage of studies concerning this disorder, and treatment of colonic volvulus remains controversial. Methods This is a retrospective study of 34 patients who presented with colonic volvulus at a single academic institution in a 4-year period and their respective treatment and outcomes. Results A total of 34 patients, 17 males (50%) and 17 females (50%), with a mean age of 55 ± 23.9 years underwent treatment for colonic volvulus. Twelve patients (35.3%) underwent initial decompression, followed by a Hartman procedure in 4 patients (11.7%) and sigmoid resection with primary anastomosis in 3 patients (8.8%), with 3 fatalities (8.8%) following initial decompression. Two patients (5.8%) were lost to follow-up. Twenty-two patients (64.7%) underwent emergency surgery, of whom 16 (47%) underwent a Hartman procedure, with colorectal anastomosis in 9 patients (26.4%), with 3 fatalities (8.8%) immediately after the first procedure. Four patients (11.7%) were lost to follow up after the Hartman procedure. Of the 6 remaining patients (17.6%), of the emergency surgical group, 3 patients (8.8%) had an initial sigmoidectomy and primary anastomosis, and the remaining 3 patients (8.8%) had a cecal volvulus with a right hemicolectomy performed with primary anastomosis in 2 patients (5.8%) and with a fatality in the remaining patient, on whom a terminal ileostomy was performed for damage control. The mean hospital stay was 5.7 days, with an overall mortality rate of 23.5%. Conclusion Acute colonic volvulus in our region is not as uncommon as in other parts of the world. This disorder must be suspected when a patient presents with abdominal pain, abdominal distension, and bean sign on plain X-rays and/or a whirl sign on computed tomography scan.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.,Hospital Metropolitano "Dr. Bernardo Sepúlveda," Secretaria de Salud de Nuevo León, San Nicolás de los Garza, México
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.,Hospital Metropolitano "Dr. Bernardo Sepúlveda," Secretaria de Salud de Nuevo León, San Nicolás de los Garza, México
| | - Gerardo Gil-Galindo
- Hospital Metropolitano "Dr. Bernardo Sepúlveda," Secretaria de Salud de Nuevo León, San Nicolás de los Garza, México
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Bhandari TR, Shahi S, Poudel R. Colonic Volvulus: An Experience at Tertiary Care Hospital in Nepal. Cureus 2019; 11:e5165. [PMID: 31528515 PMCID: PMC6743661 DOI: 10.7759/cureus.5165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Colonic volvulus is not an uncommon cause of large bowel obstruction. Limited research has been done about colonic volvulus in our part of the world which has been regarded as "volvulus belt." The aim of this study is to evaluate the clinical features, management, and factors affecting perioperative outcomes in patients with colonic volvulus. Methods: A retrospective review of medical records of all patients managed for colonic volvulus in Universal College of Medical Sciences, Bhairahawa from January 2012 to December 2016 was done. Data on patient demographics, clinical course, methods of treatment, and outcomes were analyzed. Results: A total of 62 patients (46 males) were studied. Mean age was 57.9 ± 10.4 years. The most common site involved was sigmoid (85.5%). The diagnosis was made by abdominal x-rays in 39 patients (62.2%), CT scan in 13 patients (21%), and laparotomy in 10 patients (16.1%). Fifty-eight patients (93.5%) were treated surgically. Resection and ostomy was the commonest operation performed in 30 patients (48.7%) followed by resection with anastomosis in 24 patients (38.7%). The overall complication was 38.7%. There were 9.7% of deaths. In multivariate analysis, age ( ≥ 60 years) (odds ratio (OR); 27.0, confidence interval (CI); (1.92-403), P; 0.01), preoperative hypotension (systolic blood pressure <90 mmHg) (OR; 7.82, CI; (1.19-51.2), P; 0.03), and gangrenous bowel (OR; 76.7, CI (3.60-1632), P; 0.005) were significant predictors of postoperative complications . Conclusions: Volvulus of the colon is common in males and constipation is being commonest risk factors for volvulus. Surgeons should have a high index of suspicion and should be aware of these problems to make the early diagnosis with prompt treatment and to ensure better patient outcomes in volvulus endemic areas like ours.
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Affiliation(s)
- Tika R Bhandari
- Surgery, People's Dental College and Hospital, Kathmandu, NPL
| | - Sudha Shahi
- Otorhinolaryngology, National Academy of Medical Sciences, Kathmandu, NPL
| | - Rajesh Poudel
- Surgery, Universal College of Medical Sciences, Bhairahawa, NPL
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Quénéhervé L, Dagouat C, Le Rhun M, Perez-Cuadrado Robles E, Duchalais E, Bruley des Varannes S, Touchefeu Y, Chapelle N, Coron E. Outcomes of first-line endoscopic management for patients with sigmoid volvulus. Dig Liver Dis 2019; 51:386-390. [PMID: 30377062 DOI: 10.1016/j.dld.2018.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/27/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery. AIM The aim of this study was to compare death rate between elective sigmoidectomy and conservative management following endoscopic detorsion for sigmoid volvulus. METHODS The medical records of 83 patients undergoing endoscopic detorsion of a sigmoid volvulus from 2008 to 2014 were retrospectively reviewed. Patients were divided into two groups: 'elective surgery' and 'no surgery'. RESULTS Patients in the 'no surgery' group (n = 42) were older and had more loss of autonomy than in the 'elective surgery' group. Volvulus endoscopic detorsion was successful in 96% of patients with no complications. The median follow-up was 13 months (1 day-67 months). The death rate was 62% in the 'no surgery' group versus 32% in the 'elective surgery' group (p = 0.02). In the 'no surgery' group, 23/42 of patients had volvulus recurrence. No recurrence occurred after surgery. CONCLUSION Elective surgery must be planned as soon as possible after the first episode of sigmoid volvulus. In frail patients, other options must be developed.
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Affiliation(s)
- Lucille Quénéhervé
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France.
| | - Caroline Dagouat
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | - Marianne Le Rhun
- Clinical Gerontology Department, University Hospital of Nantes, France
| | | | - Emilie Duchalais
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | | | - Yann Touchefeu
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | - Nicolas Chapelle
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | - Emmanuel Coron
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
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Panteleimonitis S, Nash G. Gastroscope guidewire volvulus tube decompression. Tech Coloproctol 2019; 23:385-386. [PMID: 30719575 DOI: 10.1007/s10151-019-01933-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- S Panteleimonitis
- Poole Hospital NHS Trust, Poole, UK. .,School of Health Sciences and Social Work, University of Portsmouth, James Watson West, Portsmouth, UK.
| | - G Nash
- Poole Hospital NHS Trust, Poole, UK
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12
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Prediction of the Clinical Outcomes of Sigmoid Volvulus by Abdominal X-Ray: AXIS Classification System. Gastroenterol Res Pract 2018; 2018:8493235. [PMID: 30581464 PMCID: PMC6276422 DOI: 10.1155/2018/8493235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/18/2018] [Indexed: 11/25/2022] Open
Abstract
Aim Early diagnosis and evaluation of the severity of sigmoid volvulus are necessary for management and early intervention. We developed a new predictive classification system for sigmoid volvulus based on X-ray findings. Methods We retrospectively analyzed 66 patients diagnosed with sigmoid volvulus using the electronic medical records at the Osaki Citizen's Hospital and the University of Tokyo Hospital from 2008–2015. We classified patients according to the coffee-bean sign mesenteric axis on X-ray (AXIS classification: group A, 0–90°; group B, 90–135°; and group C, >135°). We examined the association between AXIS classification and severe sigmoid volvulus, intestinal necrosis, need for surgery, 30-day mortality, and length of stay using the Cochran–Armitage trend test. Results In total, 66 patients were analyzed. They had a mean age of 76.9 years, and 47 (71.0%) were male. They were classified into three groups according to the AXIS classification system (group A, 40 patients; group B, 23 patients; and group C, 3 patients). Group C had a significantly higher frequency of severe sigmoid volvulus (100%) compared to group B (30%) and group A (15%). AXIS classification was significantly associated with the severity of sigmoid volvulus (p = 0.003), necrosis (p = 0.004), and need for surgery (p = 0.001), but not with the 30-day mortality or the length of stay. Conclusions We developed the AXIS classification system to predict the severity of sigmoid volvulus. This new classification system may facilitate triage and therapeutic decision-making for sigmoid volvulus patients.
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Garfinkle R, Morin N, Ghitulescu G, Vasilevsky CA, Boutros M. From Endoscopic Detorsion to Sigmoid Colectomy—The Art of Managing Patients with Sigmoid Volvulus: A Survey of the Members of the American Society of Colon and Rectal Surgeons. Am Surg 2018. [DOI: 10.1177/000313481808400961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study queried American Society of Colon and Rectal Surgeons members for management of sigmoid volvulus and aimed to determine whether surgeon experience impacts decision-making. American Society of Colon and Rectal Surgeons members received a 16-item survey in March, 2017. Items included endoscopic detorsion technique and colonic decompression, preoperative dietary considerations, surgical approach, and respondents’ demographics. Respondents were separated into low experience (LE; ≤10 years in practice) and high experience (HE; >10 years in practice). Of 1996 survey recipients, 10 per cent (197) responded; 124 were HE and 73 were LE. Most were fellowship-trained (93.8%) and primarily in colorectal surgery practice (74.6%), however only 27.4 per cent managed >20 sigmoid volvulus cases as attendings. Fifty-two per cent use rectal tubes for continued colonic decompression after successful endoscopic detorsion; 81.2 per cent would perform sigmoid colectomy on the index admission after successful detorsion, but within a variable timeframe (one to seven days postdetorsion) and with variable dietary restrictions in the interval period; 49.7 per cent would perform a laparoscopic colectomy and 68.3 per cent would perform a stapled colorectal anastomosis. LE surgeons reported a higher proportion of gastrointestinal-performed endoscopic detorsions (P = 0.015), were more likely allow regular diet in the interval period (P = 0.031), and were more inclined to use laparoscopy (P = 0.008), versus HE surgeons. There remains controversy among many of the components in the management of sigmoid volvulus after successful endoscopic detorsion.
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Affiliation(s)
- Richard Garfinkle
- From the Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - Nancy Morin
- From the Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - Gabriela Ghitulescu
- From the Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - Carol-Ann Vasilevsky
- From the Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - Marylise Boutros
- From the Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
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14
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Abstract
BACKGROUND Sigmoid volvulus is an uncommon cause of bowel obstruction that is historically associated with high morbidity and mortality. The objective of this study was to evaluate contemporary management of sigmoid volvulus and the safety of primary anastomosis in patients with sigmoid volvulus. METHODS The National Surgical Quality Improvement Project from 2012 to 2015 was queried for patients with colonic volvulus who underwent left-sided colonic resection. A propensity score-matched analysis was performed to compare patients with sigmoid volvulus undergoing colectomy with primary anastomosis without proximal diversion to colectomy with end colostomy. RESULTS Two thousand five hundred thirty-eight patients with sigmoid volvulus were included for analysis. Patients had a median age of 68 years (interquartile range, 55-80) and 79% were fully independent preoperatively. Fifty-one percent of operations were performed emergently. One thousand eight hundred thirteen (71%) patients underwent colectomy with anastomosis, 240 (10%) colectomy with anastomosis and proximal diversion, and 485 (19%) colectomy with end colostomy. Overall, 30-day mortality and morbidity were 5 and 40%, respectively. After propensity score matching, mortality, overall morbidity, and serious morbidity were similar between groups. CONCLUSIONS Sigmoid volvulus occurs in elderly and debilitated patients with significant morbidity, mortality, and lifestyle implications. In selected patients, anastomosis without proximal diversion in patients with sigmoid volvulus results in similar outcomes to colectomy with end colostomy.
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15
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Zarokosta M, Piperos Τ, Zoulamoglou M, Theodoropoulos P, Nikou E, Flessas I, Boumpa E, Bonatsos V, Noussios G, Mariolis-Sapsakos T. Anomalous course of the sigmoid colon and the mesosigmoid encountered during colectomy. A case report of a redundant loop of sigmoid colon. Int J Surg Case Rep 2018; 46:20-23. [PMID: 29655020 PMCID: PMC6000771 DOI: 10.1016/j.ijscr.2018.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/22/2018] [Accepted: 02/24/2018] [Indexed: 01/14/2023] Open
Abstract
Introduction Sigmoid colon constitutes a part of the large intestine that presents several congenital anatomic variations. In particular, the presence of a redundant loop of sigmoid colon is of tremendous importance for surgeons, obstetricians and radiologists, since it is closely related to multiple pathological conditions and functional implications of the neighboring anatomical structures. PRESENTATION OF CASE An unusual anatomic variation in position and length of the sigmoid colon and its mesocolon was unexpectedly detected during right hemicolectomy to a 67-year-old Caucasian male patient due to colon cancer. The operation was uneventful. A meticulous review of the literature was conducted as well. DISCUSSION A redundant loop of sigmoid colon may go unnoticed or it might lead to urinary, digestive and vascular complications. Its presence is associated with acute and chronic pathological conditions, sigmoid volvulus and serious confusions in radiological diagnosis and instrumentation. CONCLUSION Surgeons' thorough knowledge concerning this rare anatomic variation is fundamental and crucial in order to establish a correct diagnosis and assert the appropriate management when performing operations including pelvis and abdomen.
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Affiliation(s)
- Maria Zarokosta
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece.
| | - Τheodoros Piperos
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece
| | - Menelaos Zoulamoglou
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece
| | - Panagiotis Theodoropoulos
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece
| | - Euthumios Nikou
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece
| | - Ioannis Flessas
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece
| | - Eleni Boumpa
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece
| | - Vasileios Bonatsos
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece
| | - George Noussios
- Department of Physical Education and Sports Sciences, "Aristotles", University of Thessaloniki, Serres, Greece
| | - Theodoros Mariolis-Sapsakos
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece
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Sarfaraz M, Hasan SR, Lateef S. Sigmoid volvulus in young patients: Ą new twist on an old diagnosis. Intractable Rare Dis Res 2017; 6:219-223. [PMID: 28944147 PMCID: PMC5608935 DOI: 10.5582/irdr.2017.01033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
According to the literature, sigmoid volvulus typically develops in patients of an older age with co-morbidities such as a psychiatric illness or a bed-bound chronic illness. Recent reports suggest that it should also be considered in young individuals without any preceding medical history. Abdominal roentgenography is a cheap and effective diagnostic modality that can avoid a delay in diagnosis. The treatment of colonic volvulus remains controversial and relies upon the procedure selected and the most appropriate therapeutic approach in terms of the clinical status of the patient, the location of the problem, the suspected existence or identification of peritonitis, bowel viability, and the expertise of the surgical team. Presented here are four cases of young male patients with sigmoid volvulus. All of the patients were diagnosed radiologically prior to surgical intervention. Two of the patients initially underwent an endoscopic procedure that succeeded in one and that failed in the other. Three of the patients underwent a laparotomy.
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Affiliation(s)
- Moaziz Sarfaraz
- Emergency Department, Fujairah Hospital, Fujairah, United Arab Emirate
- Address correspondence to: Dr. Moaziz Sarfaraz, Emergency Department, Fujairah Hospital, Fujairah, U.A.E. E-mail:
| | - Syeda Rana Hasan
- Department of Preventive Medicine, Fujairah, United Arab Emirate
| | - Shahid Lateef
- Department of Surgery, Kalba Hospital, Kalba, Sharjah, United Arab Emirate
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17
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Abstract
An acute sigmoid volvulus is due to the torsion of the sigmoid colon around its mesenteric axis. It mainly occurs in elderly patients and represents an abdominal emergency requiring urgent treatment. A 53-year-old male patient with severe craniocerebral injury and traumatic subarachnoidal bleeding 3 weeks prior presented on the ward with distended abdomen without abdominal pain, muscular defense, or resistances. He featured large volume diarrhea within the last few hours without signs of bleeding. A plain abdominal X-ray demonstrated a coffee bean sign indicating a sigmoid volvulus. A consequent CT scan of the abdomen revealed a deep outlet obstruction with massively dilated, elongated and twisted loop of the sigmoid colon and no signs of perforation. We performed emergency colonoscopy under the assumption of an acute sigmoid volvulus. After careful insertion of the endoscope completely refraining from insufflation of air or CO2, endoscopic reposition of the sigma could be achieved and a colonic drainage was placed over an inserted guide wire up to the proximal transverse colon. No relapse occurred and a diagnostic colonoscopy after 4 weeks revealed no tumor or polyps. Our report describes a classic case of acute sigmoid volvulus and undermines the potential of colonoscopy as conservative primary treatment of choice.
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Affiliation(s)
- Michael Scharl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Luc Biedermann
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
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18
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Iida T, Nakagaki S, Satoh S, Shimizu H, Kaneto H, Nakase H. Clinical outcomes of sigmoid colon volvulus: identification of the factors associated with successful endoscopic detorsion. Intest Res 2017; 15:215-220. [PMID: 28522952 PMCID: PMC5430014 DOI: 10.5217/ir.2017.15.2.215] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 12/03/2022] Open
Abstract
Background/Aims Although multiple treatment options exist for the management of sigmoid colon volvulus, no study has examined the factors associated with successful endoscopic detorsion. This study aimed to examine the clinical course of patients with sigmoid colon volvulus and to identify factors related to successful endoscopic detorsion. Methods This study included 30 cases (21 patients) of sigmoid volvulus from among 545 cases of intestinal obstruction at a single center. We retrospectively examined the clinical course and the factors associated with the possibility of endoscopic detorsion of sigmoid colon volvulus. Results The rate of laxative use among the study participants was 76.2%; the rate of comorbid neuropsychiatric disorders was 61.9%; and 57.1% of patients had a history of open abdominal surgery. All patients were initially treated with endoscopic detorsion, and this procedure had a 61.9% success rate. The recurrence rate after detorsion was as high as 46.2%, but detorsion during revision endoscopy was possible in all cases. Statistical analysis revealed that the absence of abdominal tenderness (P=0.027), the use of laxatives (P=0.027), and a history of open abdominal surgery (P=0.032) were factors predictive of successful endoscopic detorsion. Conclusions The results of our study are consistent with previous reports with respect to the success rate of endoscopic detorsion, the subsequent recurrence rate, and the proportion of patients requiring surgical treatment. In addition, we identified the absence of abdominal tenderness, the use of laxatives, and history of open abdominal surgery as factors predicting successful endoscopic detorsion of sigmoid colon volvulus.
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Affiliation(s)
- Tomoya Iida
- Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan
| | - Suguru Nakagaki
- Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan
| | - Shuji Satoh
- Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan
| | - Haruo Shimizu
- Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan
| | - Hiroyuki Kaneto
- Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Abstract
Volvulus of the intestines may involve either the small bowel or colon. In the pediatric population, small bowel volvulus is more common, while in the adult population, colonic volvulus is more often seen. The two most common types of colonic volvulus include sigmoid and cecal volvulus. Prompt diagnosis and treatment is imperative, otherwise bowel ischemia may ensue. Treatment often involves emergent surgical exploration and bowel resection.
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Affiliation(s)
- Muneera R Kapadia
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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20
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Usability of elective laparoscopic sigmoidectomy and feasibility of single-incision laparoscopic surgery for sigmoid volvulus: report of three cases. Int Surg 2016; 100:408-13. [PMID: 25785318 DOI: 10.9738/intsurg-d-14-00080.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A therapeutic guideline for sigmoid volvulus (SV) has not been established, and the most recommended surgical procedure for SV has not been determined. Our objective is to assess the usability of elective laparoscopic sigmoidectomy and the feasibility of single-incision laparoscopic surgery for SV following endoscopic reduction. SV typically affects the elderly and accounts for 1% to 7% of intestinal obstructions in Western countries. We report on 3 patients with SV who underwent elective laparoscopic sigmoidectomy following endoscopic reduction, and we first describe single-port surgery for SV. We discuss the 3 patients (a 79-year-old male, an 88-year-old female, and a 67-year-old female) with SV who underwent elective laparoscopic sigmoidectomy following endoscopic reduction. All 3 patients underwent laparoscopic sigmoidectomy, and 2 patients underwent single-port laparoscopic surgery without complications. Recurrence of volvulus was not seen during the course of 12 to 24 months. In experienced hands, elective laparoscopic sigmoidectomy after colonoscopic detorsion is a valuable alternative, and single-port surgery is also feasible.
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21
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22
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Frank L, Moran A, Beaton C. Use of percutaneous endoscopic colostomy (PEC) to treat sigmoid volvulus: a systematic review. Endosc Int Open 2016; 4:E737-41. [PMID: 27556086 PMCID: PMC4993950 DOI: 10.1055/s-0042-106957] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 04/11/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND AIM Percutaneous endoscopic colostomy provides an alternative management option for patients with recurrent sigmoid volvulus who are considered too high risk to undergo surgery. We reviewed the literature to assess whether the National Institute for Health and Clinical Excellence guidelines published in 2006 supporting the use of percutaneous endoscopic colostomy are still valid. METHODS A systematic literature search was conducted using PubMed, Web of Science, and Embase. The exploded search terms "Percutaneous Endoscopic Colostomy" and "Sigmoid Volvulus" were used. Librarian support was used to ensure the maximum number of relevant articles were returned. Identified abstracts were then analyzed and included if they met the inclusion criteria. RESULTS Five observational studies and 5 case reports were identified that met the inclusion criteria. They provided data on 56 patients with recurrent sigmoid volvulus treated with percutaneous endoscopic colostomy placement. Sixteen of the 56 patients were treated with a single percutaneous endoscopic colostomy (PEC) tube while 38 patients were treated with 2 PEC tubes. For 2 patients the details of the procedure were unknown. Five patients developed major complications following the procedure: 1 patient developed peritonitis after 4 days, due to fecal contamination secondary to tube migration and 2 patients with cognitive impairment pulled their PEC tubes out. Two other patients died following PEC insertion. Nine patients developed minor complications following the procedure. The most commonly reported minor complication was infection at the PEC site. Four of 56 patients developed a recurrent sigmoid volvulus with a PEC tube in situ. CONCLUSION Although in these case series there is a 21 % risk of morbidity and 5 % risk of mortality from the use of a PEC, this is favorable compared to the mortality risk of 6.6 % to 44 % reported with operative intervention. This review of contemporary literature therefore supports the use of PEC in frail and elderly patients.
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Affiliation(s)
- Lucinda Frank
- Department of Colorectal Surgery, North Devon District Hospital, Barnstaple,Corresponding author: Lucinda Frank Department of Colorectal SurgeryNorth Devon District HospitalRaleigh Park, Barnstaple, Devon EX31 4JB
| | - Alex Moran
- Department of Gastroenterology, North Devon District Hospital, Barnstaple
| | - Ceri Beaton
- Department of Colorectal Surgery, North Devon District Hospital, Barnstaple
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23
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Atamanalp SS, Atamanalp RS. The role of sigmoidoscopy in thediagnosis and treatment of sigmoid volvulus. Pak J Med Sci 2016; 32:244-8. [PMID: 27022384 PMCID: PMC4795878 DOI: 10.12669/pjms.321.8410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Sigmoid volvulus (SV) is a rare form of acute intestinal obstruction in which the sigmoid colon wraps around itself. The disease generally presents as a mechanical bowel obstruction with clinical features that are not pathognomonic. Similarly, X-ray films are not diagnostic in most cases. It is difficult to establish the correct preoperative diagnosis when CT and MRI are not used. The principal strategy in the treatment of SV in uncomplicated patients is emergency endoscopic detorsion followed by elective surgery; emergent surgery is required in patients with bowel gangrene, bowel perforation, peritonitis, or unsuccessful endoscopic treatment. In this review, we have discussed the role of sigmoidoscopy in the diagnosis and treatment of SV. Additionally, we have retrospectively and prospectively evaluated our 49-year, 987-patient clinical experience, the largest single-center SV series ever reported.
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Affiliation(s)
- Sabri Selcuk Atamanalp
- Prof. Sabri Selcuk Atamanalp, MD, Department of General Surgery, Faculty of Medicine, Ataturk University, 25040, Erzurum, Turkey
| | - Refik Selim Atamanalp
- Refik Selim Atamanalp, English Medicine Program, Faculty of Medicine, Ataturk University, 25040, Erzurum, Turkey
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Bruzzi M, Lefèvre JH, Desaint B, Nion-Larmurier I, Bennis M, Chafai N, Tiret E, Parc Y. Management of acute sigmoid volvulus: short- and long-term results. Colorectal Dis 2015; 17:922-8. [PMID: 25808350 DOI: 10.1111/codi.12959] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/13/2015] [Indexed: 02/08/2023]
Abstract
AIM The best form of prophylactic management of a decompressed sigmoid volvulus (SV) is controversial especially in the elderly. We have studied our experience with this condition to assess the short- and long-term results of SV management. METHOD All patients treated for SV in our department between 2003 and 2013 were retrospectively included. Emergency decompression was attempted in all patients in whom there was no sign of peritonitis. Planned surgical resection was the procedure of choice in young patients. Percutaneous endoscopic colopexy (PEC) was used in high surgical risk patients. RESULTS There were 65 patients (45 males) of median age 71.5 (24-99) years. Non-surgical reduction was performed in 62 with a success rate of 95% (59/62). Recurrence after initial decompression was 67% at a median follow-up of 5 (1-14) years. A prophylactic surgical resection was performed with primary anastomosis in 33 patients. There were no deaths and the major morbidity rate was 6%. At a mean follow-up of 62 months, only 1 (3%) patient had had a recurrence (at 130 months). PEC was performed in six patients of median age 90 (84-99) years and with a median American Society of Anesthesiologists score of 4. Complications included local site infection (n = 2), pain (n = 1) and abdominal wall bleeding (n = 1). After a median follow-up of 2 (1-4) years, three patients died from medical causes and one recurrence occurred 13 months after removal of the PEC tube. CONCLUSION Prophylactic treatment after initial decompression of SV results in a low rate of recurrence. Planned sigmoid resection is safe and effective. In frail elderly patients, PEC is satisfactory.
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Affiliation(s)
- M Bruzzi
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - J H Lefèvre
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - B Desaint
- Department of Gastroenterology and Endoscopy, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - I Nion-Larmurier
- Department of Gastroenterology and Endoscopy, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - M Bennis
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - N Chafai
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - E Tiret
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
| | - Y Parc
- Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France
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Gyedu A, Abantanga F, Kyei I, Boakye G, Stewart BT. Changing Epidemiology of Intestinal Obstruction in Ghana: Signs of Increasing Surgical Capacity and an Aging Population. Dig Surg 2015; 32:389-96. [PMID: 26315569 DOI: 10.1159/000438798] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/16/2015] [Indexed: 12/10/2022]
Abstract
INTRODUCTION This study aimed to describe the epidemiology and outcomes of intestinal obstruction at a tertiary hospital in Ghana over time. METHODS Records of all patients admitted to a tertiary hospital from 2007 to 2011 with intestinal obstruction were identified using ICD-9 codes. Sociodemographic and clinical data were compared to a previously published series of intestinal obstructions from 1998 to 2003. Factors contributing to longer than expected hospital stays and death were further examined. RESULTS Of the 230 records reviewed, 108 patients (47%) had obstructions due to adhesions, 50 (21%) had volvulus, 22 (7%) had an ileus from perforation and 14 (6%) had intussusception. Hernia fell from the 1st to the 8th most common cause of obstruction. Patients with intestinal obstruction were older in 2007-2011 compared to those presenting between 1998 and 2003 (p < 0.001); conditions associated with older age (e.g., volvulus and neoplasia) were more frequently encountered (p < 0.001). Age over 50 years was strong factor of in-hospital death (adjusted OR 14.2, 95% CI 1.41-142.95). CONCLUSION Efforts to reduce hernia backlog and expand the surgical workforce may have had an effect on intestinal obstruction epidemiology in Ghana. Increasing aging-related pathology and a higher risk of death in elderly patients suggest that improvement in geriatric surgical care is urgently needed.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Sugimoto S, Mizukami T. Diagnostic and therapeutic applications of water-immersion colonoscopy. World J Gastroenterol 2015; 21:6451-6459. [PMID: 26074684 PMCID: PMC4458756 DOI: 10.3748/wjg.v21.i21.6451] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/15/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy techniques combining or replacing air insufflation with water infusion are becoming increasingly popular. They were originally designed to reduce colonic spasms, facilitate cecal intubation, and lower patient discomfort and the need for sedation. These maneuvers straighten the rectosigmoid colon and enable the colonoscope to be inserted deeply without causing looping of the colon. Water-immersion colonoscopy minimizes colonic distension and improves visibility by introducing a small amount of water. In addition, since pain during colonoscopy indicates risk of bowel perforation and sedation masks this important warning, this method has the potential to be the favored insertion technique because it promotes patient safety without sedation. Recently, this water-immersion method has not only been used for colonoscope insertion, but has also been applied to therapy for sigmoid volvulus, removal of lesions, lower gastrointestinal bleeding, and therapeutic diagnosis of abnormal bowel morphology and irritable bowel syndrome. Although a larger sample size and prospective head-to-head-designed studies will be needed, this review focuses on the usefulness of water-immersion colonoscopy for diagnostic and therapeutic applications.
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Kasten KR, Marcello PW, Roberts PL, Read TE, Schoetz DJ, Hall JF, Francone TD, Ricciardi R. What are the results of colonic volvulus surgery? Dis Colon Rectum 2015; 58:502-7. [PMID: 25850837 DOI: 10.1097/dcr.0000000000000340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Operative results of volvulus are largely unknown because of infrequent diagnosis. OBJECTIVE We examined the results of operative intervention for colonic volvulus. DESIGN We merged trackable data from the California Inpatient Database with Supplemental Files for Revisit Analyses between January 1, 2005, and December 31, 2007. SETTINGS Trackable data from California discharge records. PATIENTS We identified all of the patients with colonic volvulus who underwent 1 of 4 surgical procedures, including manipulation/fixation of the colon, right colectomy, left colectomy, or total colectomy. MAIN OUTCOME MEASURES During the 36-month study period, we identified recurrence risk, recurrence requiring reoperation, time to reoperation, stoma formation, disposition on discharge, and in-hospital mortality. Fisher exact, χ(2), and ANOVA tests were used when appropriate. RESULTS We identified 2141 patients with colonic volvulus who were undergoing intraoperative manipulation/fixation of the colon (n = 209 (12%)), right (n = 728 (41%)), left (n = 781 (44%)), or total colectomy (n = 56 (3%)). Patients treated with intraoperative manipulation/fixation were younger, more likely to be women, and more likely to have private insurance. Patients who underwent total colectomy had the highest risk of mortality (21%), highest risk of stoma creation (64%), and longest length of stay (18 days); were more likely to be readmitted (9%); and were the most likely to be discharged to a skilled nursing facility (48%). Patients treated with intraoperative manipulation/fixation had the lowest mortality, risk of stoma formation, length of stay, and likelihood of discharge to skilled nursing facility but the highest risk of subsequent procedures for volvulus (26%) over a follow-up ranging from 0 to 687 days. LIMITATIONS This study was limited by retrospective study design, heterogeneous patient factors, and inability to identify the time of last follow-up. CONCLUSIONS The majority of patients with volvulus underwent a resectional procedure. A subset without resection had favorable initial outcomes but remained at high risk for subsequent procedures. There may be a potential role for evaluating intraoperative manipulation/fixation in a small subset of patients with colonic volvulus.
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Affiliation(s)
- Kevin R Kasten
- Department of Colorectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
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Role of the enteric nervous system in the elongated sigmoid colon of patients with sigmoid volvulus. Int Surg 2014; 99:699-704. [PMID: 25437573 DOI: 10.9738/intsurg-d-13-00198.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To clarify the physiologic function of the enteric nervous system (ENS) in the elongated sigmoid colon (ESC) of patients with sigmoid volvulus (SV), we examined the enteric nerve responses in lesional and normal longitudinal muscle strips (LMS) derived from patients with ESC and patients who underwent colon resection for colonic cancers. Thirty preparations of LMS were taken from the lesional sigmoid colons of 10 ESC patients with SV (8 men and 2 women, aged 53 to 80 years, mean 66.2 years). Forty preparations of LMS were taken from the normal sigmoid colons (NSC) of 20 patients with colonic cancer (12 men and 8 women, aged 55 to 76 years, mean 62.3 years). A mechanographic technique was used to evaluate in vitro muscle responses to electrical field stimulation (EFS) before and after treatment with various autonomic nerve blockers. Response to EFS before blockade of the adrenergic and cholinergic nerves was as follows: NSC and ESC significantly demonstrated relaxation reaction rather than contraction reaction (P = 0.0253, P < 0.0001, respectively). ESC showed relaxation reaction more than NSC (P = 0.1138). Response to EFS after blockade of the adrenergic and cholinergic nerves was as follows: NSC and ESC significantly demonstrated relaxation reaction via nonadrenergic noncholinergic (NANC) inhibitory nerves rather than contraction reaction via NANC excitatory nerves (P < 0.0001, P < 0.0001, respectively). ESC with SV significantly showed relaxation reaction more than NSC (P = 0.0092). An increased response of relaxation mediated NANC inhibitory nerves may play a role in impaired motility in the ESC of patients with SV.
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Comparison of two surgical techniques for resection of uncomplicated sigmoid volvulus: Laparoscopy or open surgical approach? J Visc Surg 2014; 151:431-4. [DOI: 10.1016/j.jviscsurg.2014.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kumar S, Gautam S, Prakash R, Sidhartha K, Shashikant. Volvulus of sigmoid colon during full term pregnancy with rectovaginal fistula: a case report. J Clin Diagn Res 2014; 8:ND15-6. [PMID: 25478399 DOI: 10.7860/jcdr/2014/9196.4990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 08/06/2014] [Indexed: 11/24/2022]
Abstract
Intestinal obstruction due to sigmoid colon volvulus during pregnancy is a rare complication but associated with significant fetomaternal mortality. We describe a case of sigmoid volvulus in a patient with 37 wk pregnancy causing huge dilation of left colon. Patient developed rectovaginal fistula following nonmedical method to relieve distention by inserting stick as told by patient.
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Affiliation(s)
- Sanjeev Kumar
- Senior Resident, Department of General Surgery, King George's Medical University , U.P., Lucknow, India
| | - Shefali Gautam
- Senior Resident, Department of Anaesthesiology, King George's Medical University , U.P., Lucknow, India
| | - Ravi Prakash
- Senior Resident, Department of Anaesthesiology, King George's Medical University , U.P., Lucknow, India
| | - Kanishka Sidhartha
- Junior Resident, Department of General Surgery, King George's Medical University , U.P., Lucknow, India
| | - Shashikant
- Senior Resident, Department of General Surgery, King George's Medical University , U.P., Lucknow, India
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Sugimoto S, Hosoe N, Mizukami T, Tsunoda Y, Ito T, Imamura S, Tamura T, Nagakubo S, Morohoshi Y, Koike Y, Fujita Y, Komatsu H, Ogata H, Kanai T. Effectiveness and clinical results of endoscopic management of sigmoid volvulus using unsedated water-immersion colonoscopy. Dig Endosc 2014; 26:564-8. [PMID: 24533946 DOI: 10.1111/den.12235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/06/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Although intestinal obstruction as a result of sigmoid volvulus (SV) may be successfully resolved using endoscopic detorsion, surgical treatment remains the main therapeutic strategy. We evaluated the endoscopic detorsion procedure using unsedated water-immersion colonoscopy for the treatment of SV. METHODS A retrospective chart review was conducted on the clinical background and prognosis of 21 SV patients who underwent 71 endoscopic detorsion procedures using unsedated, water-immersion colonoscopy. RESULTS In all, 14 (67%) male and seven (33%) female patients, with a mean age of 73 years (range, 54-95 years) were enrolled; 86% were >70 years of age. Among these patients, 90% had a background of key predisposing factors. In the 21 patients, endoscopic detorsion was successfully done using unsedated water-immersion colonoscopy. SV recurred in 10 patients at a median of 180 days. Endoscopic detorsion for recurrent SV was successfully achieved in all cases, and none of the secondary cases became severe. Only male patients were observed to experience three or more recurrent episodes of SV. CONCLUSIONS SV occurred most commonly in elderly patients with a surgical risk. Our experience suggests that conservative endoscopic treatment using unsedated water-immersion colonoscopy is a safe, reasonable, conservative endoscopic approach for elderly patients in the absence of necrotic findings. We currently use this procedure in most of our cases.
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Affiliation(s)
- Shinya Sugimoto
- Department of Gastroenterology, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, Tokyo, Japan
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Traoré D, Sanogo Z, Bengaly B, Sissoko F, Coulibaly B, Togola B, Traoré I, Goïta D, Keïta S, Togo A, Diallo G, Sangaré D, Ongoïba N, Koumaré A. Acute sigmoid volvulus: Results of surgical treatment in the teaching hospitals of Bamako. J Visc Surg 2014; 151:97-101. [DOI: 10.1016/j.jviscsurg.2014.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
BACKGROUND AND OBJECTIVES Sigmoid gangrene develops in 6.1% to 93.4% of sigmoid volvulus (SV) cases, and increases the mortality rate from 0% to 40% without bowel gangrene to 3.7% to 80%. This study aimed to investigate factors that induce bowel gangrene development in SV patients. DESIGN AND SETTINGS Retrospective study from a single center. PATIENTS AND METHODS We determined whether there was any correlation between sigmoid gangrene and the following factors: age, gender, a previous history of a volvulus, previous history of abdominal surgery, pregnancy, major comorbidities, shock, duration of symptoms, direction and degree of rotation of volvulus, and ileosigmoid knotting. RESULTS Of 442 patients, 271 (61.3%) had sigmoid gangrene. The presence of pregnancy was negatively cor.related with sigmoid gangrene development (P < .05), while comorbid diseases (P < .01), associated shock (P < .01), prolonged symptom duration (P < .05), overrotation (P < .05), and associated ileosigmoid knotting (P < .01) were positively correlated with bowel gangrene. However, no correlation was observed between sigmoid gangrene and the other studied factors. CONCLUSION An inverse correlation between pregnancy and sigmoid gangrene was observed. On the other hand, a positive correlation was noted between bowel gangrene and comorbid diseases, shock, prolonged duration of symptoms, overrotation, and associated ileosigmoid knotting.
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Affiliation(s)
- Sabri Selcuk Atamanalp
- Faculty of Medicine, Department of General Surgery, Ataturk University, Erzurum 25070, Turkey.
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Mnguni MN, Islam J, Manzini V, Govindasamy V, Zulu BMW, Clarke DL, Madiba TE. How far has the pendulum swung in the surgical management of sigmoid volvulus? Experience from the KwaZulu-Natal Teaching Hospitals and review of the literature. Colorectal Dis 2012; 14:1531-7. [PMID: 22487185 DOI: 10.1111/j.1463-1318.2012.03046.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM Sigmoid volvulus is common in sub-Saharan Africa. The aim of the study was to document the clinicopathological patterns of sigmoid volvulus in KwaZulu-Natal. METHOD Analysis was performed of prospectively collected data of patients presenting with sigmoid volvulus at the KwaZulu-Natal Teaching Hospitals from 2000 to 2009. Data collected included demographics, clinical presentation, operative findings, management and outcome. RESULTS There were 135 patients (122 male) of mean age 39.3 ± 17 years. Management was by emergency surgery (103), elective surgery (23), no surgery (9). The level of the twist was at the pelvic brim. Fifty-four patients had gangrenous bowel and 81 had viable bowel. Resection was accompanied by primary anastomosis (80) and Hartmann's procedure (46). Complication and mortality rates were 47% and 17% respectively. Mortality rates for emergency and elective surgery were 19% and 9% (P = 0.330), and those for primary anastomosis and Hartmann's procedure were 14% and 24% respectively (P = 0.305). Mortality rates for gangrenous and viable bowel were 21% and 15% respectively (P = 0.624). Twenty-eight (22%) patients required intensive care in the intensive care unit (ICU) with an ICU stay of 8.8 ± 8 days. Hospital stay was 10.5 ± 14.4 days. CONCLUSION The clinicopathological picture of sigmoid volvulus resembles that in the rest of Africa in that it affects predominantly young African males. The level of the twist is at the pelvic brim. The timing of surgery, the type of anastomosis and the viability of the bowel does not influence outcome.
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Affiliation(s)
- M N Mnguni
- Department of Surgery, University of KwaZulu-Natal Teaching Hospitals, Congella, South Africa
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Chang CJ, Hsieh TH, Tsai KC, Fan CM. Sigmoid volvulus in a young woman nearly misdiagnosed as fecal impaction. J Emerg Med 2012; 44:611-3. [PMID: 23079147 DOI: 10.1016/j.jemermed.2012.02.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 09/12/2011] [Accepted: 02/19/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Volvulus of the sigmoid colon is a potentially life-threatening condition rarely seen in younger age groups and is male predominant. OBJECTIVE We report a previously healthy young woman with the triad of constipation, progressive abdominal distension, and severe abdominal pain, with plain-film x-ray studies mimicking stool impaction and computed tomography disclosing the typical findings of sigmoid volvulus. The case reminds Emergency Physicians to consider sigmoid volvulus if mechanical obstruction is suspected, even in a young patient. CASE REPORT A 33-year-old woman had the triad of symptoms for 3 days. Physical examination did not show peritoneal signs. Digital rectal examination disclosed neither palpable mass nor stool in rectum. Computed tomography revealed "coffee bean" sign and "whirl" sign. Laparoscopy demonstrated redundant sigmoid colon and she was treated with detorsion with colopexy uneventfully. CONCLUSIONS Sigmoid volvulus is rarely seen in developed countries. Clinical manifestations vary with disease progression, but it typically presents with a triad of constipation, progressive abdominal distension, and severe abdominal pain. Plain-film x-ray studies can demonstrate a coffee bean or "omega loop" (inverted-U sigmoid) sign in <60% cases, but it was reported as high as 86% in computed tomography. The whirl sign on computed tomography might also be observed. The cause is multifactorial and colonic length is the most important predisposing factor. Flexible colon fiberscopic decompression followed by elective definitive surgery is the treatment choice, but exploratory laparotomy is mandatory if any complicated entity occurs. The mortality rate is still >50% when bowel gangrene develops.
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Affiliation(s)
- Chih-Jung Chang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
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Yassaie O, Thompson-Fawcett M, Rossaak J. Management of sigmoid volvulus: is early surgery justifiable? ANZ J Surg 2012; 83:74-8. [DOI: 10.1111/j.1445-2197.2012.06182.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Omid Yassaie
- Department of Surgery; Tauranga Hospital; Tauranga; New Zealand
| | - Mark Thompson-Fawcett
- Department of Surgical Sciences; University of Otago, Dunedin Hospital; Dunedin; New Zealand
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Sigmoid volvulus treated by resection and primary anastomosis: urgent and elective conditions as risk factors for postoperative morbidity and mortality. Eur J Trauma Emerg Surg 2012; 38:463-6. [PMID: 26816129 DOI: 10.1007/s00068-012-0191-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 04/09/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Sigmoid volvulus is a major cause of intestinal obstruction. The aim of this study is to analyze urgent and elective conditions as risk factors for morbidity and mortality regarding sigmoid colon resection and primary anastomosis in patients with sigmoid volvulus. METHODS This retrospective study included 63 patients diagnosed with sigmoid volvulus, who underwent sigmoid colon resection plus primary anastomosis under urgent or elective conditions between January 1994 and December 2010. RESULTS Sigmoid colon resection plus anastomosis was performed in 63 patients; 31 (49.2 %) under urgent conditions, while 32 (50.8 %) were performed electively. The mean age of the patients was 65.2 ± 15.2 (18-95) years. The patients consisted of 50 (79.4 %) men and 13 (20.6 %) women. There were no statistical significances between groups in terms of age, gender, associated diseases, and hospital stay. Postoperative morbidity occurred in 30.2 % of patients. The morbidity rates for the urgent group and the elective group were 35.5 and 25.0 %, respectively (p = 0.419). Wound infection, pneumonia, and evisceration were the most common postoperative complications. Wound infection was higher in the urgent group (p = 0.026). In terms of other complications, the groups were similar. Total mortality occurred in 19.4 % of the urgent group and 15.6 % of the elective group (p = 0.750). CONCLUSION Sigmoid colon resection plus primary anastomosis-related morbidity and mortality rates were similar in patients who were operated on under urgent and elective conditions, and who maintained good general condition.
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Abstract
BACKGROUND Management approaches for colonic volvulus are infrequently described in the literature in the United States, and many studies only report operative cases. OBJECTIVE The aim of this study was to define the demographics, diagnostic and treatment approaches, and outcomes for patients with this disorder in the United States. DESIGN This study is a retrospective review. SETTINGS The study was conducted at a 7-hospital health system. PATIENTS All patients diagnosed with colonic volvulus by International Classification of Diseases, Ninth Revision code were included. MAIN OUTCOME MEASURES The primary outcomes measured were recurrence, complications, and mortality. RESULTS One hundred three cases of volvulus (50 sigmoid, 53 cecal) were identified in 92 patients. Compared with cecal volvulus, sigmoid volvulus was more common in men, patients with neurologic diagnoses, and residents of skilled nursing home. Eighty-five percent of the cases presented were acutely obstructed. The diagnosis was established by abdominal x-ray (17%), contrast enema study (27%), CT scan (35%), or laparotomy (17%). Abdominal x-rays were insufficient for definitive diagnosis in 85% of cecal and 49% of sigmoid cases (p = 0.002). All patients with cecal volvulus were treated surgically. Seventy-nine percent of patients with sigmoid volvulus underwent successful nonoperative reduction, of whom 38% had subsequent surgery. Fifty-eight percent of patients with sigmoid volvulus were treated operatively. Resection with primary anastomosis was chosen in most cases (78%). Resection with end ostomy (10%), reduction and pexy (7%), and reduction alone (4%) were other approaches. The mortality rate was 5% (cecal 0%, sigmoid 10%; p = 0.012). There were no readmissions for recurrent cecal volvulus. Nonoperative treatment for sigmoid volvulus often failed (48%). Complication rates were higher in sigmoid volvulus cases (cecal 17%, sigmoid 34%; p = 0.047). LIMITATIONS This study was limited by its retrospective, nonexperimental design. CONCLUSIONS Although incidences of cecal and sigmoid volvulus are similar in the present series, sigmoid volvuli are more common in men, individuals with neurologic disease, and residents of nursing homes. Plain radiograph is insufficient to confirm cecal volvulus. The diagnosis is most often made with CT scans. The nonoperative management of sigmoid volvulus is associated with a high recurrence rate.
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Volvulus of the Sigmoid Colon during Pregnancy: A Case Report. Case Rep Obstet Gynecol 2012; 2012:641093. [PMID: 22567527 PMCID: PMC3335546 DOI: 10.1155/2012/641093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 11/10/2011] [Indexed: 12/19/2022] Open
Abstract
Colonic obstruction due to sigmoid colon volvulus during pregnancy is a rare but complication with significant maternal and fetal mortality. We describe a case of sigmoid volvulus in a patient with 33 weeks of gestation that developed complete necrosis of the left colon. Case. 27-year-old woman was admitted with 3 days of abdominal distention, vomit, and the stoppage of the passage of gases and feces. She was admitted with poor clinical conditions with septic shock, acute respiratory distress syndrome, and signs of diffuse peritonitis. Abdominal radiography showed severe dilation of the colon with horseshoe signal suggesting a sigmoid volvulus, pneumoperitoneum and we could not we could not identify fetal heartbeats. With a diagnosis of complicate sigmoid volvulus she was underwent to the laparotomy where we found necrosis of all descending colon due to double twist volvulus of the sigmoid. We performed a colectomy with a confection of a proximal colostomy, and closing of the rectal stump. Due to an uncontrollable uterine bleeding during cesarean due, it was required a hysterectomy. The patient had an uneventful postoperative course thereafter and was discharged on a regular diet on the 15th postoperative day.
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Ferrada PA, Arora T, Anand RJ. A Case of Sigmoid Volvulus and Floppy Cecum: A Therapeutic Dilemma. Am Surg 2011. [DOI: 10.1177/000313481107700907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paula A. Ferrada
- Virginia Commonwealth University Medical Center Richmond, Virginia
| | - Tania Arora
- Virginia Commonwealth University Medical Center Richmond, Virginia
| | - Rahul J. Anand
- Virginia Commonwealth University Medical Center Richmond, Virginia
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Atamanalp SS, Ozturk G. Sigmoid volvulus in the elderly: outcomes of a 43-year, 453-patient experience. Surg Today 2011; 41:514-9. [PMID: 21431484 DOI: 10.1007/s00595-010-4317-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 02/22/2010] [Indexed: 02/06/2023]
Abstract
PURPOSE The present study reviewed the clinical outcomes of 453 elderly patients with sigmoid volvulus (SV). METHODS The clinical records were reviewed retrospectively. RESULTS The mean patient age was 71.1 years of age, and 371 patients (81.9%) were male. Of the patients, 30.7% had recurrent volvulus, 34.6% had associated disease, and 16.5% suffered from shock. The correct diagnosis rate based on the clinical features was 66.4%. Radiography revealed SV findings in 64.9% of the patients. Computed tomography (CT) or magnetic resonance imaging (MRI) were diagnostic in all cases. Nonoperative detorsion was performed in 323 patients (71.3%) with 77.4% success, 1.2% mortality, 4.0% morbidity, and 4.4% early recurrence rates. Emergency surgery was required in 215 patients (47.5%) and resulted in 24.2% mortality, 41.4% morbidity, 0.9% early recurrence, and 8.1% late recurrence rates. CONCLUSIONS Elderly SV patients generally present with high percentages of recurrent volvulus, serious comorbidity, late admission, and shock. The clinical features may be less diagnostic. Radiological studies, particularly CT or MRI, may assist in an SV diagnosis. Nonoperative detorsion is advocated as the primary treatment. In emergency surgery, nonresectional or nonanastomotic procedures are preferred. The overall patient prognosis is grave, and the disease tends to recur.
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Affiliation(s)
- S Selcuk Atamanalp
- Department of General Surgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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Codina Cazador A, Farres Coll R, Olivet Pujol F, Pujadas de Palol M, Martín Grillo A, Gomez Romeu N, Julia Bergkvist D. [Colonic volvulus and recurrence of volvulus: what should we do?]. Cir Esp 2011; 89:237-42. [PMID: 21333281 DOI: 10.1016/j.ciresp.2010.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 12/21/2010] [Accepted: 12/22/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Colonic volvulus (CV) is an uncommon disease in our country, which may present clinically as an intestinal obstruction or occlusion. Its diagnosis and therapeutic management remains controversial. The objective of this article is to present our series, analyse the results and establish a therapeutic approach to decrease the recurrence of the volvulus. MATERIAL AND METHODS A retrospective, descriptive study of patients diagnosed with CV between January 1997 and December 2009. RESULTS The study included 54 patients, with a mean age of 74 years, who had a total of 89 CV episodes. There was associated disease in 70% of the cases, which included 44% with constipation and 53% with neurological diseases. The volvulus was located in the sigmoid in 87% of cases and in the right colon in 13%. The large majority (92%) of cases had intestinal obstruction. Endoscopic treatment was effective in 61% and urgent surgery was performed in 31% of the cases, and in 40% of the first episodes of CV. There was recurrence of volvulus in 62% of cases treated with surgery, and surgery was performed in 72% of these. In the whole series, surgery was performed in 35 cases (64%), with sigmoidectomy with primary anastomosis being the technique most employed. The overall mortality of the series was 7 cases (12%), with 16% being in cases of surgery due to recurrence. CONCLUSIONS The diagnostic technique and initial treatment of CV is endoscopic decompression. Early elective surgery prevents the high recurrence rate associated with higher mortality.
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Affiliation(s)
- Antonio Codina Cazador
- Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Girona Dr. J. Trueta, Girona, España.
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Akinkuotu A, Samuel JC, Msiska N, Mvula C, Charles AG. The role of the anatomy of the sigmoid colon in developing sigmoid volvulus: a case-control study. Clin Anat 2011; 24:634-7. [PMID: 21322064 DOI: 10.1002/ca.21131] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 12/05/2010] [Accepted: 12/09/2010] [Indexed: 12/15/2022]
Abstract
Sigmoid volvulus is a common condition throughout much of the world. To this date, there are no adequately controlled clinical trials examining the role of anatomy in sigmoid volvulus. Therefore, the objective of this study was to determine if the anatomic dimensions of the sigmoid colon differ in sigmoid volvulus compared to controls. This prospective case-control study was conducted at Kamuzu Central Hospital, Lilongwe, Malawi. Cases included individuals 18 years or older with surgically confirmed sigmoid volvulus, while controls included individuals undergoing surgery for reasons unrelated to the descending or sigmoid colon, or rectum. Intraoperative measurements of the sigmoid colon were taken, including mesosigmoid root width and mesosigmoid length. A total of 26 cases and 12 controls were enrolled. When compared to controls, the mesosigmoid of cases had a greater length and maximal width; however, mesosigmoid root width was similar between groups. These findings support the assertion that sigmoid volvulus is due to a long and wide mesosigmoid that rotates on a constant mesosigmoid root width. This is the first adequately controlled trial examining anatomy in sigmoid volvulus and provides strong evidence that refines prior hypotheses regarding the anatomic basis of sigmoid volvulus.
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Affiliation(s)
- Adesola Akinkuotu
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina 27599, USA
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Tan KK, Chong CS, Sim R. Management of acute sigmoid volvulus: an institution's experience over 9 years. World J Surg 2010; 34:1943-8. [PMID: 20372894 DOI: 10.1007/s00268-010-0563-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Management of sigmoid volvulus is often challenging because of its prevalence in high-risk patients and the associated perioperative morbidity and mortality rates. This study was designed to review the management and outcome of all patients admitted with sigmoid volvulus. METHODS A retrospective review of all patients who were admitted for sigmoid volvulus from October 2001 to June 2009 was performed. Diagnosis was confirmed on clinical evaluation, radiological studies, and/or intraoperative findings. RESULTS Seventy-one patients, median age 73 (range, 17-96) years, were admitted a total of 134 times for acute sigmoid volvulus during the study period. The majority (n = 51, 71.8%) were older than aged 60 years, and 41 (57.7%) had at least one premorbid condition. Seven (9.9%) patients underwent emergency surgery on presentation. The remaining 64 (90.1%) patients were initially managed conservatively using a flatus tube and/or sigmoidoscopic decompression. One patient had an endoscopic-related perforation and required emergency surgery. Another ten patients failed conservative management for which nine underwent operative intervention. The last patient refused surgery and died subsequently. Fifty-three (74.6%) patients had successful conservative management; seven of them underwent elective surgery subsequently. Of the remaining 46 patients, 28 (60.9%) were admitted for recurrent sigmoid volvulus. Of these 28 patients, 12 eventually had elective surgery after successful decompression, whereas the remaining 16 were not operated. In our series, three patients died after emergency surgery and there was no mortality after elective surgery. Another six patients died from medical conditions that were unrelated to sigmoid volvulus. CONCLUSIONS Acute sigmoid volvulus is a surgical emergency, although the majority (75%) can be successfully decompressed nonoperatively. Emergency surgery in these patients is associated with a mortality of 17.6% in our series. Elective definitive surgery is suggested in view of the high recurrence rate (>60%) and the considerable risks of emergency surgery.
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Affiliation(s)
- Ker-Kan Tan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
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Ichise Y, Horiuchi A, Nakayama Y, Tanaka N. Techniques and Outcomes of Endoscopic Decompression Using Transanal Drainage Tube Placement for Acute Left-sided Colorectal Obstruction. Gastroenterology Res 2010; 3:201-206. [PMID: 27956997 PMCID: PMC5139716 DOI: 10.4021/gr233w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2010] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND If it is possible, endoscopic decompression for acute left-sided colorectal obstruction will be effective in critically ill patients. This study was to evaluate the techniques and outcomes of transanal drainage tube placement following urgent colonoscopy in management of acute left-sided colorectal obstruction. METHODS From January 2000 to December 2009, 69 consecutive patients (36 males, age 38 to 94, mean = 71) were hospitalized because of acute left-sided colorectal obstruction. Urgent colonoscopy was performed within 12 hours of entry for diagnosis and treatment (mean time, 6.5 hours). Endoscopic decompression using a transanal drainage tube was attempted. Clinical success, methods used, and complications were retrospectively evaluated. RESULTS The cause of obstruction was colorectal carcinoma in 66 patients (96%). The site of obstruction was sigmoid colon in 37 (54%), rectum in 20 (29%), and descending colon in 12 (17%). Out of 69 patients, endoscopic decompression using the transanal drainage tube was successful in 66 (96%). The use of combination of transanal drainage tube and the equipped guidewire enabled endoscopic decompression was successful in 45 patients (65%), though a small-diameter upper endoscope was used in 2 patients to introduce the guidewire beyond the obstruction. Perforation during the placement developed in 2 patients and one patient was unsuccessful. CONCLUSIONS Transanal drainage tube placement following urgent colonoscopy was effective in the management of acute left-sided colorectal obstruction. In the majority of patients, the materials and methods used for the transanal drainage tube placement were simple and easy.
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Affiliation(s)
- Yasuyuki Ichise
- Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane, Japan
| | - Akira Horiuchi
- Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane, Japan
| | - Yoshiko Nakayama
- Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane, Japan; Department of Pediatrics, Shinshu University School of Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Naoki Tanaka
- Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane, Japan; Department of Metabolic Regulation, Shinshu University Graduate School of Medicine, Matsumoto, Japan
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Martin MJ, Steele SR. Twists and turns: a practical approach to volvulus and intussusception. Scand J Surg 2010; 99:93-102. [PMID: 20679045 DOI: 10.1177/145749691009900210] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M J Martin
- Trauma and Emergency Surgery Service, Legacy Emanuel Hospital, Portland, OR, USA.
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Une occlusion colique chez un africain. Rev Med Interne 2010; 31:312-4. [DOI: 10.1016/j.revmed.2009.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 03/07/2009] [Indexed: 11/18/2022]
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Apport du scanner multi-détecteurs dans la prise en charge des volvulus du sigmoïde. ACTA ACUST UNITED AC 2010; 91:213-20. [DOI: 10.1016/s0221-0363(10)70026-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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