Colonic Volvulus Incidence 7 per 100 000 in uk



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Colonic Volvulus

  • Incidence 1.7 per 100 000 in UK

  • Wide geographical variation

  • Elderly psychiatric institutionalised patients

  • Mortality 7-30% per episode



Dilemma ? why

  • No randomised trials

  • No controlled trials

  • No prospective audits

  • Small retrospective studies

  • Few up to date studies





Management options

  • Non operative decompression

  • Surgical resection

  • Colopexy procedures

  • Percutaneous endoscopic colostomy (PEC)

  • No treatment



Non operative decompression

  • Widely accepted

  • Rigid sigmoidoscope or colonoscope

  • 90% successful

  • 5-8% mortality

  • 22-90% recurrence



Surgery (1) Non viable bowel

  • Resection (Hartmanns)

  • Mortality 0-75%



Surgery (2) Viable bowel

  • Early surgery

  • Mortality (elective) 0-15%

  • Choice of operation/survival

  • ? Laparoscopic





Surgery (3) Sigmoid colectomy

  • Good results in able bodied

  • Sigmoid colectomy + anastomosis 37% recurrence

  • Sigmoid colectomy + stoma 20% recurrence

  • Associated mega colon 82% recurrence

  • Mortality 0-15%



Surgery (4) Non resection

    • Mesocoloplasty: mortality 40% recurrence 27%
    • Colopexy: mortality 11% recurrence 21%
    • Tube sigmoidostomy: mortality 0% recurrence 0%


Percutaneous endoscopic colostomy (PEC)

  • Simpson et al BJS 2000

  • 14 patients

  • No deaths

  • Tube removed 8 (3 recurred)

  • Tube in situ 5 (0 recurred)



PEC



PEC (Sheffield)

  • In Sheffield 11 date (Dr Mark McAlindon)

  • 2 leaks

  • 1 patient washout and PEC retained later converted to stoma

  • 1 patient ITU emergency colostomy



Ceacal volvulus

  • Colonoscopic de-rotation: high failure rate + delays operation

  • Ceacostomy, Caecopexy or Right hemicolectomy

  • Similar mortality (9 and 4.5%)

  • 30% recurrence after ceacopexy

  • 0% recurrence after tube ceacostomy



? No Treatment



Sigmoid volvulus (unfit patient)



Sigmoid volvulus (fit patient)




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