The objective of this study was to evaluate contemporary management of sigmoid volvulus and the safety of primary anastomosis in patients with sigmoid volvulus. It has usually been considered to be a disease of the elderly, but recent reports emphasize that young and middleaged adults are also susceptible. The long mesentery of the sigmoid colon which increases with age means that this segment bowel is more prone to twisting on its mesenteric base fig. Colonic volvulus is the third leading cause of colonic obstruction in the world, following colorectal cancer and complicated sigmoid diverticulitis 2. Sigmoid volvulus is a common cause of obstruction worldwide. Diagnosis and treatment of caecal volvulus postgraduate. Sigmoid volvulus emergency medicine jama jama network. The initial treatment of sigmoid colon volvulus is sigmoidoscopy with rectal tube placement.
The clinical manifestations, diagnosis, and management of cecal volvulus are discussed here. The term volvulus comes from the latin volvere meaning twist. This disease has been described for centuries, and was studied by hippocrates himself. Feb 20, 2020 baker dm, wardrop pj, burrell h, hardcastle jd.
Nonoperative management of the sigmoid volvulus case presentation socea et al 620 vol. Sigmoid volvulus is a cause of large bowel obstruction and occurs when the sigmoid colon twists on its mesentery, the sigmoid mesocolon. Surgical management of a sigmoid volvulus includes resection of a portion of the bowel with either a reconnecting of the bowel or colostomy formation. Sigmoid volvulus is an extremely rare cause of abdominal pain in children. Management of the colonic volvulus in 2016 emconsulte. Fortyone consecutive patients with acute sigmoid volvulus were prospectively randomized into 2 groups to compare percutaneous deflation prior to emergency tube decompression followed electively by colopexy with banding n20 versus emergency tube. Minimal invasiv management of sigmoid volvulus youtube. As, primary anastomosis or stoma still a subject of debate. Tannouri, 2017 children eventually diagnosed with colonic volvulus often undergo multiple radiographic evaluations, often due to equivocal results. Acute sigmoid volvulus in children jama pediatrics. Ghaem hospital of mashhad, university of medical sciences, mashhad, iran, from 1996 to 2008.
An algorithm for the management of sigmoid colon volvulus and the safety of primary resection. Patients with sigmoid volvulus are often in the sixth to eighth decades of life and frequently have concomitant chronic illnesses, such as cardiac, pulmonary, and renal disease, that significantly influence their outcome. Contemporary management of sigmoid volvulus springerlink. Pdf a study on various modalities of surgical management of. The aim of this study was to describe the management of sigmoid volvulus, the type of surgical procedures performed and to determine the prognosis of sigmoid volvulus. A cecal volvulus is the rotation or torsion of a mobile cecum and ascending colon, which causes approximately 1 to 3 percent of all large bowel obstructions. It can affect all parts of the colon, but most commonly occurs in the sigmoid and cecal areas.
The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudoobstruction this is one of a series of statements discussing the use of gastrointestinal endoscopy in common clinical situations. Management of acute sigmoid volvulus in a provincial centrea 20year experience paul vb fagan, brad stanfield, talat nur, nigel henderson, falah elhaddawi, stephen kyle s igmoid volvulus is associated with a high rate of recurrence with nonoperative treatment14 and conservative management has been associated with high. Sigmoid volvulus is the mostcommon form of volvulus of the gastrointestinal tract. Therefore, often, a conservative approach to management is chosen. The management of acute sigmoid volvulus anderson 1981. In western countries, sigmoid volvulus preferentially affects elderly men whereas cecal volvulus affects younger women. Although volvulus of all individual segments of the colon has been reported, sigmoid volvulus is by far the most common, followed by cecal volvulus. Worldwide incidence of sigmoid volvulus varies from 630%. It remains a rare but important intestinal obstruction 1, 3. The most common sites of volvulus are the sigmoid colon and cecum. Retrospective study on pattern and outcome of management of. Cecal volvulus with associated small bowel obstruction. The effects of twisting the sigmoid colon vary from mild mechanical obstruction to catastrophic gangrene.
Flexible sigmoidoscopy is commonly performed for the confirmation and initial management of sigmoid volvulus, however the utility of endoscopic therapy in acute caecal volvulus diagnosis and treatment is generally considered limited, 2 as the success rate of colonoscopic reduction of caecal volvulus has been about 30%. Volvulus can also arise as a rare complication in persons with redundant colon, a normal anatomic variation resulting in extra colonic loops. Sigmoid volvulus is a gastrointestinal condition that frequently leads to large bowel obstruction characterized by a twisted sigmoid colon. Prophylactic treatment after sigmoid volvulus decom pression is recommended because of a high rate of recurrence. An algorithm for the management of sigmoid colon volvulus. Nov 28, 2018 barium enema of sigmoid volvulus revealing termination of contrast in birdsbeak formation at base of volvulus. Volvulus can develop in any part of the gastrointestinal tract including stomach, small intestine, cecum, and sigmoid colon. A prospective randomized trial the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. When the diagnosis is made preoperatively, decompression per rectum is effective in 85 per cent of cases, and should be the initial treatment of choice unless gangrene of the bowel is suspected.
Aug 02, 2017 sigmoid volvulus is a gastrointestinal condition that frequently leads to large bowel obstruction characterized by a twisted sigmoid colon. Management of acute sigmoid volvulus in a provincial. The sigmoid colon is an sshaped part of the colon that is in the left lower side of the abdomen, above the rectum. Tannouri, 2017 important to convey your concerns to radiologist to help give herhim context to consider results within. Abdominal radiograph and ct scan helped in diagnosis. G, ercp cannula and guidewire across the volvulus for endoscopic decompression and detorsion. Most commonly, this is the result of chronic constipation and the. Sigmoid volvulus is the commonest cause of large bowel obstruction in many regions of the world. Colonic volvulus is a common cause of large bowel obstruction worldwide. Listen for highpitched bowel sounds, peristaltic rushes, or absence of bowel sounds.
When the diagnosis is made preoperatively, decompression per rectum is effective in 85 per cent of cases, and should be. Some risk factors, such as chronic constipation, highfiber diet, frequent use of laxatives, personal past history of laparotomy. Colonic volvulus is the third leading cause of colonic obstruction worldwide, occurring at two principal locations. In this article, learn about the causes and symptoms in both adults and children, as well as how a. Volvulus is the third most common cause of large bowel obstruction in the united states. Volvulus clinical features investigations management. Many cases of sigmoid volvulus have been treated successfully with noninvasive decompression techniques but again surgery is the recommended treatment due to a high recurrence rate in noninvasive procedures. Volvulus leads to acute bowel obstruction and can progress to strangulation, necrosis, and perforation. However, there are virtually no reports of acute sigmoid volvulus occurring in children. In cecal volvulus, endoscopy has no role and surgery is the rule. With age, this part of the colon or its attachments to the abdominal wall stretch out, allowing it to twist on itself, similar to the twisting of a long balloon, resulting in a volvulus. Endoscopic treatment of sigmoid volvulus this video demonstrates the endoscopic treatment of a sigmoid volvulus. Volvulus occurs most frequently in middleaged and elderly men.
The role of endoscopy in the management of patients with. The epidemiology and clinical pattern of sigmoid volvulus are well defined. These features were suggestive of sigmoid volvulus. A study on sigmoid volvulus presentation and management authorstream presentation. Lower gastrointestinal contrast study showed very redundant sigmoid colonic loop. A clinical study of sigmoid volvulus international journal. If there is malrotation at the time of fetal development then it can make that baby vulnerable to having volvulus. Feb 26, 2011 volvulus nursing, medical, surgical managements 1. A study on sigmoid volvulus presentation and management.
Volvulus refers to torsion of a segment of the alimentary tract, which often leads to bowel obstruction. Diagnostic doubt is not uncommon in cecal volvulus. A case of acute sigmoid volvulus in a 14yearold adolescent girl presenting with acute low large bowel obstruction with a background of chronic constipation has been presented. The evaluation and management of colon volvulus twisted bowel include endoscopic andor operative. As such, this article will mainly focus on the risk factors, clinical presentation, and management of a sigmoid volvulus. There was no evidence of hemodynamic instability or peritonitis on examination. Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly. Clinical practice guidelines for colon volvulus and acute.
In the volvulus belt of africa and the middle east, 20%50% of bowel obstructions are a result of volvulus almost exclusively of the sigmoid colon. Resection is mandatory for gangrene and a grossly distended, thinwalled cecum. Acute volvulus of the sigmoid colon is a welldefined emergency abdominal condition in adults. Delay in diagnosis and treatment of sigmoid and cecal volvulus is associated with substantial morbidity and mortality. Journal of the college of physicians and surgeons pakistan 2014, vol.
It depends on the extent of bowel injury to help determine which is the more appropriate approach. Volvulus is an emergent medical condition and requires medical attention immediately. Any mobile segment of the colon can be affected by volvulus 3. Extent of resection required for sigmoid volvulus is limited to resection of omega loop of sigmoid volvulus and resection of sigmoid mesentery. Lower gastrointestinal contrast study showed very redundant sigmoid. Volvulus in the pediatric population commonly occurs in the small bowel associated with malrotation or internal hernia whereas sigmoid volvulus sv is extremely rare. She underwent emergency colonoscopic detorsion and decompression uneventfully. American society for gastrointestinal endoscopy guideline on. The most common location of volvulus is the sigmoid colon. More commonly seen in older adults, an sv occurs when a redundant loop of sigmoid wraps around its elongated, narrow mesentery causing obstruction and ischemia to the affected bowel segment. Surgical management of sigmoid volvulus maria georgiades, md october 18, 2012. F, endoscopic treatment of sigmoid volvulus with water immersion technique and guidewire.
The symptoms that indicate the occurrence of volvulus is abdominal pain, nausea, severe constipation and blood in stool. Pdf management of acute volvulus of the sigmoid colon. The standards of practice committee of the american society for gastrointestinal endoscopy asge prepared. Sigmoid volvulus occurs in cases of longstanding chronic constipation where patients develop a large, elongated, relatively atonic colon, particularly in the sigmoid.
To describe the management of sigmoid volvulus with reference to the type of surgical procedures performed and to determine the prognosis of sigmoid volvulus. The frontline treatment for sigmoid volvulus is an emergent surgery to untwist the sigmoid. Sigmoid volvulus typically occurs in older patients who have multiple co. Management of acute sigmoid volvulus in a provincial centrea. Ad, previous sigmoid volvulus treated with endoscopic detorsion.
Cecopexy and cecostomy seem lesseffective and more morbid options than. Mar 01, 2018 18 year old lady with recurrence sigmoid volvulus and previous laparotomy colopexy was underwent colonoscopy colon intubation and elective laparoscopic sigmoidectomy. Management of sigmoid volvulus avoiding sigmoid resection. Sigmoid volvulus management in developing country at university. Sigmoid volvulus is a lifethreatening condition that results from the rotation of the sigmoid colon on its mesenteric axis leading to a closedloop obstruction.
Safioleas m, chatziconstantinou c, felekouras e, et al. Sigmoid volvulus is an uncommon cause of bowel obstruction that is historically associated with high morbidity and mortality. American society for gastrointestinal endoscopy guideline. Cecal volvulus is second only to sigmoid volvulus in its frequency of occurrence. An 80yearold man who was receiving palliative treatment for metastatic head and neck cancer presented with abdominal distension and pain. Mar 08, 2019 the frontline treatment for sigmoid volvulus is an emergent surgery to untwist the sigmoid. Acute sigmoid volvulus sv is a wellrecognized cause of acute large bowel obstruction. Management of sigmoid volvulus is often challenging because of its prevalence in highrisk patients and the associated perioperative morbidity and mortality rates. Colonic volvulus occurs when the bowel twists on its mesentery, causing obstruction and ischemic changes.
The basic problem in management of the patients is a high incidence of. Sigmoid volvulus is a serious condition that is predominant in adults. The most common location of volvulus is the sigmoid colon 60%, followed by cecal volvulus 2040%. Studies report a mortality of 3040% in patients in whom diagnosis and treatment of cecal volvulus are delayed. The management of acute sigmoid volvulus in nottingham. Sigmoid volvulus may occur because of sigmoid elongation, resulting in a redundant loop. If untreated, cecal volvulus can progress to bowel ischemia, necrosis, or perforation.
Although clinical manifestations of acute volvulus are often clearcut, diagnostic doubt is not uncommon and, if gangrene supervenes, mortality rises appreciably. It is a type of volvulus that gives rise to discrepancies in the bowel, causing intestinal blockage. Colonic volvulus occurs when the bowel twists on its. Epidemiology large bowel volvulus accounts for 5% of all large bowel obstructions, with 60% of intestinal. Listing a study does not mean it has been evaluated by the u. Case presentation o 20 yo male with abdominal distention, nausea and 1 episode of emesis o passed flatus one day prior to admission. Nov 28, 2018 delay in diagnosis and treatment of sigmoid and cecal volvulus is associated with substantial morbidity and mortality. The epidemiology and clinicai pattern of sigmoid volvulus are well deflned. The full text of this article is available in pdf format. He notes that he has had occasional episodes of severe pain in llq similar to this but have resolved on there own.
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