Volvulus 嘉義長庚醫院 大腸直腸外科



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tarix01.05.2017
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Volvulus

  • 嘉義長庚醫院

  • 大腸直腸外科

  • 葉重宏




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




Yüklə 445 b.

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