Volvulus

嘉義長庚醫院大腸直腸外科葉重宏

• Colon twists on its own mesenteric axis

• venous congestion and infarction

• Gangrene

• Arterial supply comprised

• Ischemia

Distribution

• Sigmoid colon : Most common

• Cecum

• T-Colon

• Splenic flexure

Sigmoid Volvulus

• Prevalence

: 3% ~ 30% in large bowel obstruction

• Country

• Age

Pathogenesis• The pathogenesis is obscure• Chronic constipation• High fiber diet• Chronic medical or psychiatric

problem• Precipitating factor

: pregnancy, abdominal surgery

Symptoms and Signs

• Colicky abdominal pain

• Constipation

• Failure to pass flatus

• Abdominal distension

• Nausea

• Vomiting

DiagnosisSupine abdominal X-ray

-- Bent inner tire sign

BAE: complete retrograde obstruction

-- Bird’s beak sign

Colonoscopy or sigmoidoscopy

TreatmentNon-operative procedure• Successful rate : 70 % ~ 90 %

• Rigid sigmoidoscopy with rectal tube decompression : left in place for 48 hours

• Colonoscopy

• Recurrent rate : 43% ~ 57 % in 2 years

Operative Treatment

• Indication Unsuccessful reduction

Nonviability of colon

Elective surgery after reduction

• Procedure Sigmoid colectomy and anastomosis

Hartmann’s procedure

Detorsion and sigmoidpexy -- avoid

• Mortality 8 % -- elective surgery

28 % -- emergent surgery

• Risk factor Old age

Emergent surgery

Nonviable colon

Previous history of volvulus

Cecal Volvulus• Prevalence : 25 % ~ 30 % of all volvulus

• Precipitating factor Distal colon obstruction Colonic atony

Pregnancy Prolong constipation

Prior abdominal surgery Mesenteric adenitis

Congenital band Jogging

Violent cough

Intermittent positive pressure breathing

Meteorism in unpressurized air travel

• S/S -- Acute intestinal obstruction

• Diagnosis Pain ABD :

--- Coffee bean shape

BAE :

--- Bird’s beak deformity of cecum

Treatment

• Colonoscopy is not recommended

• Surgery Detorsion

Detorsion and cecopexy

Cecostomy

R’t hemicolectomy

Volvulus and Pregnancy

• Prevalence of intestinal obstruction

--- 3 / 100,000 pregnancies

• 25 % was caused by volvulus