Volvulus 嘉義長庚醫院 大腸直腸外科

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

Diagnosis

• Supine abdominal X-ray

• -- Bent inner tire sign

• BAE: complete retrograde obstruction

• -- Bird’s beak sign

• Colonoscopy or sigmoidoscopy

Treatment

• Non-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