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Journal of Visceral Surgery Jun 2016Colonic volvulus is the third leading cause of colonic obstruction worldwide, occurring at two principal locations: the sigmoid colon and cecum. In Western countries,... (Review)
Review
Colonic volvulus is the third leading cause of colonic obstruction worldwide, occurring at two principal locations: the sigmoid colon and cecum. In Western countries, sigmoid volvulus preferentially affects elderly men whereas cecal volvulus affects younger women. Some risk factors, such as chronic constipation, high-fiber diet, frequent use of laxatives, personal past history of laparotomy and anatomic predispositions, are common to both locations. Clinical symptomatology is non-specific, including a combination of abdominal pain, gaseous distention, and bowel obstruction. Abdominopelvic computerized tomography is currently the gold standard examination, allowing positive diagnosis as well as detection of complications. Specific management depends on the location, patient comorbidities and colonic wall viability, but treatment is an emergency in every case. If clinical or radiological signs of gravity are present, emergency surgery is mandatory, but is associated with high morbidity and mortality rates. For sigmoid volvulus without criteria of gravity, the ideal strategy is an endoscopic detorsion procedure followed, within 2 to 5 days, by surgery that includes a sigmoid colectomy with primary anastomosis. Exclusively endoscopic therapy must be reserved for patients who are at excessive risk for surgical intervention. In cecal volvulus, endoscopy has no role and surgery is the rule.
Topics: Colectomy; Colonic Diseases; Colonoscopy; Humans; Intestinal Obstruction; Intestinal Volvulus; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 27132752
DOI: 10.1016/j.jviscsurg.2016.03.006 -
Radiologia 2015Radiologists must be able to recognize the imaging signs of intestinal malrotation because this condition can lead to potentially lethal complications such as midgut... (Review)
Review
Radiologists must be able to recognize the imaging signs of intestinal malrotation because this condition can lead to potentially lethal complications such as midgut volvulus. The correct diagnosis depends on both high clinical suspicion and the radiologist's ability to recognize the specific signs of malrotation and the normal variants that can lead to the wrong diagnosis. Although the location of the third portion of the duodenum outside the retroperitoneal area on ultrasonography, CT, or MRI seems to be a reliable sign of malrotation, the gold standard for determining whether the duodenojejunal flexure is in an abnormal location continues to be the upper gastrointestinal series. In this article, we review the most important imaging signs of malrotation and emphasize the role of ultrasonography in diagnosing midgut volvulus.
Topics: Humans; Intestinal Volvulus; Magnetic Resonance Imaging; Radiology; Tomography, X-Ray Computed; Ultrasonography
PubMed: 25458122
DOI: 10.1016/j.rx.2014.07.007 -
Journal of Gastrointestinal Surgery :... Nov 2021
Topics: Chromosome Deletion; Chromosomes, Human, Pair 2; Humans; Intestinal Volvulus; Spleen
PubMed: 33904059
DOI: 10.1007/s11605-021-05013-1 -
Seminars in Pediatric Surgery Feb 2022Intestinal malrotation is a congenital anomaly that can be associated with midgut volvulus, requiring an emergent operation in order to maintain blood supply to the... (Review)
Review
Intestinal malrotation is a congenital anomaly that can be associated with midgut volvulus, requiring an emergent operation in order to maintain blood supply to the compromised intestine. It results from an abnormal rotation of the intestines, leading to three types of malrotation. Non-rotation is complete failure of the intestines to rotate, while the most common configuration is associated with the cecum in the mid-upper abdomen, close to a malpositioned duodenal-jejunal (DJ) flexure. This configuration has a narrow mesentery that has a high risk of volvulus. The final form of malrotation is incomplete rotation, where the DJ flexure and cecum are malpositioned, but the mesentery is not narrowed. The benefits of performing a Ladd's procedure for these individuals is controversial. Workup for malrotation should be considered in all patients who present with abdominal pain/distention and bilious emesis. An upper gastrointestinal contrast study is 93-100% sensitive and will show a corkscrew appearance when a volvulus is present. While the basic tenets of the Ladd's procedure have not changed and include detorsion of a volvulus, adhesiolysis of Ladd's bands and broadening of the mesentery, how this is accomplished and in whom are controversial. Laparoscopic Ladd's is associated with shorter hospital stays but also has a higher incidence of recurrent volvulus compared to an open approach. Patients with heterotaxy syndrome also represent a controversial group with some studies showing no difference in post-operative complications despite a higher mortality due to underlying cardiac disease, while other studies show a low incidence of volvulus and question the need for Ladd's in those who are asymptomatic. This review highlights the major aspects of diagnosing and treating malrotation, including the pathophysiology, workup, surgical options and areas of controversy.
Topics: Child; Digestive System Surgical Procedures; Humans; Intestinal Volvulus; Intestines; Laparoscopy; Postoperative Complications
PubMed: 35305800
DOI: 10.1016/j.sempedsurg.2022.151141 -
Surgical Laparoscopy, Endoscopy &... Oct 2022Minimally invasive surgery has become increasingly prevalent. However, the majority of colectomies for volvulus are still performed via an open technique. The purpose of...
PURPOSE
Minimally invasive surgery has become increasingly prevalent. However, the majority of colectomies for volvulus are still performed via an open technique. The purpose of this study is to determine whether there is a difference in outcomes between laparoscopic and open procedures for sigmoid volvulus.
MATERIALS AND METHODS
The American College of Surgeons National Surgical Quality Improvement Program and colectomy-targeted procedure databases were queried from 2013 to 2018. Patients undergoing partial colectomy without ileal resection for the indication of volvulus were compared based on approach (planned laparoscopic vs. planned open). The 2 groups were propensity score matched for perioperative variables. A subgroup analysis was performed comparing unplanned laparoscopic conversion to open (CTO) with planned open procedures. The primary outcomes were overall morbidity, mortality, and length of stay.
RESULTS
Total 2493 patients were identified. Four hundred ninety-two cases began laparoscopically (20%), of which 391 were completed laparoscopically (79%). Laparoscopic approach was associated with longer operative times (133 vs. 104 min, P <0.001). Laparoscopic approach was associated with decreased overall morbidity (OR: 0.71, 95% CI, 0.54 to 0.93) and decreased length of stay when >7 days (OR: 0.70, 95% CI, 0.52 to 0.94). On subgroup analysis, there was no difference in outcomes when comparing unplanned CTO to planned open approach.
CONCLUSIONS
Laparoscopic approach is used in a fraction of cases for colonic volvulus. When utilized, the majority are completed without CTO. Laparoscopy is associated with fewer complications and shorter hospital stays. Even with unplanned conversion to open, there is no difference in outcomes compared against planned open procedures. Surgeons should consider the utilization of laparoscopy for colonic volvulus.
Topics: Colectomy; Humans; Intestinal Volvulus; Laparoscopy; Length of Stay; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 35960695
DOI: 10.1097/SLE.0000000000001074 -
Journal of Pediatric Surgery Aug 2021Intestinal volvulus in a neonate, complete or segmental, is a true surgical emergency, which when the diagnosis is delayed can bring detrimental results. The aim of this...
BACKGROUND
Intestinal volvulus in a neonate, complete or segmental, is a true surgical emergency, which when the diagnosis is delayed can bring detrimental results. The aim of this study was to describe the clinical characteristics of intestinal volvulus during the neonatal period by comparing total midgut volvulus (TMV) and segmental volvulus (SV).
METHODS
The medical records of 44 neonates who were operated on for intestinal volvulus from 1993 to 2019 were retrospectively reviewed. The patients were divided into TMV and SV groups, and clinical features were compared.
RESULTS
Operations were performed on 27 patients for TMV and 17 for SV. All cases of TMV were associated with intestinal malrotation, while those with SV were not. Gestational age, birth weight, and ratio of prematurity showed no differences between the groups. Preoperative diagnosis of TMV or SV was possible in 23 and 5 (85% and 29%) cases, respectively. Intestinal resection was required in 16/17 patients (94%) with SV, while it was required in 5/27 (19%) patients with TMV. When bowel resection was performed in TMV, all but one patient suffered from short bowel syndrome leading to two mortalities, while SV group showed good recovery.
CONCLUSION
Diagnosis of SV before laparotomy can be difficult. Even though performing intestinal resection in SV neonates is highly likely, it shows a favorable outcome. TMV neonates are less likely to undergo intestinal resection; however, when bowel ischemia is present, significant morbidity can occur.
TYPE OF STUDY
Treatment study.
LEVEL OF EVIDENCE
Level IV.
Topics: Digestive System Abnormalities; Humans; Infant, Newborn; Intestinal Volvulus; Laparotomy; Retrospective Studies; Short Bowel Syndrome
PubMed: 33008638
DOI: 10.1016/j.jpedsurg.2020.08.029 -
Annals of the Royal College of Surgeons... Feb 2022Patients with sigmoid volvulus (SV) are at a high risk of recurrence with increased morbidity and mortality. This study aims to review whether patients with SV underwent...
INTRODUCTION
Patients with sigmoid volvulus (SV) are at a high risk of recurrence with increased morbidity and mortality. This study aims to review whether patients with SV underwent definitive surgical treatment after initial endoscopic reduction according to the guidelines, and to compare mortality rate between surgical and conservative management.
METHODS
Retrospective study conducted at East Kent Hospitals University NHS Foundation Trust, included all patients with SV between 2016 and 2018. The primary outcome was 30-day mortality following the initial management of the acute attack. Secondary outcomes were recurrence rate and overall mortality. The median follow-up period was 3 years.
RESULTS
A total of 40 patients were identified with a median age of 82 years; 27 (67%) were males. Of these 40 patients, 6 (15%) had emergency surgery, 26 (65%) received endoscopic decompression only, and 8 (20%) had planned definitive resection; 32 patients (80%) had recurrence and the median interval between any two episodes was 86 days. The mortality rate among patients with ASA grade 3 or 4 in the three groups, elective surgery, emergency surgery and decompression only, was 0%, 25% and 70% respectively, whereas it was 0%, 50% and 33% in those with ASA grade 2. The mortality rate among patients with similar ASA who had a planned surgery was significantly lower compared with those who did not undergo surgery (=0.003).
CONCLUSIONS
In patients with sigmoid volvulus, regardless of ASA grade, performing early definitive surgery following initial endoscopic decompression resulted in a statistically significant lower mortality rate.
Topics: Aged, 80 and over; Decompression, Surgical; Female; Humans; Intestinal Volvulus; Lumbar Vertebrae; Male; Retrospective Studies; Sigmoid Diseases; Treatment Outcome
PubMed: 34860119
DOI: 10.1308/rcsann.2021.0123 -
BMJ Case Reports Jan 2024Compound volvulus, also known as ileosigmoid knot, is a rare cause of intestinal obstruction due to twisting of the small bowel around the large bowel or vice-versa. It... (Review)
Review
Compound volvulus, also known as ileosigmoid knot, is a rare cause of intestinal obstruction due to twisting of the small bowel around the large bowel or vice-versa. It poses a diagnostic dilemma due to the presence of features of closed-loop obstruction of both the small and large bowel. Being a surgical emergency due to the rapid progression to gangrene of involved segments leading to septicaemia, early suspicion of the disease entity, adequate resuscitation and prompt treatment are the need of the hour. Three cases encountered and managed in our setting are described here with a review of the literature.
Topics: Humans; Colon, Sigmoid; Gangrene; Intestinal Obstruction; Intestinal Volvulus; Intestine, Small
PubMed: 38238160
DOI: 10.1136/bcr-2023-258253 -
Internal Medicine (Tokyo, Japan) Mar 2021Cecal volvulus is an uncommon cause of colonic obstruction. First-line treatment for cecal volvulus is surgery, as nonoperative management is rarely achievable. We...
Cecal volvulus is an uncommon cause of colonic obstruction. First-line treatment for cecal volvulus is surgery, as nonoperative management is rarely achievable. We herein report an extremely rare case of a patient with spontaneously resolved cecal volvulus; no recurrence occurred without elective surgery. A 47-year-old woman presented with acute lower abdominal pain. She was misdiagnosed with small bowel obstruction and treated conservatively. A few hours later, she was correctly diagnosed with cecal volvulus. Subsequently, her symptoms and computed tomography findings of cecal volvulus completely disappeared. She refused elective surgery, but no recurrence occurred during five months of follow-up.
Topics: Abdominal Pain; Cecal Diseases; Female; Humans; Intestinal Obstruction; Intestinal Volvulus; Middle Aged; Tomography, X-Ray Computed
PubMed: 33055481
DOI: 10.2169/internalmedicine.5532-20 -
The British Journal of Surgery Dec 2019
Topics: Abdominal Pain; Aged; Cecal Diseases; Constipation; Female; Humans; Intestinal Volvulus; Vomiting
PubMed: 31747064
DOI: 10.1002/bjs.11390