-
World Journal of Gastroenterology Feb 2007To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery. (Review)
Review
AIM
To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery.
METHODS
A retrospective review of the clinical presentation and imaging characteristics of 33 sigmoid volvulus patients was presented, as well as their diagnosis and treatment, in combination with a literature review.
RESULTS
In 26 patients endoscopic detorsion was achieved after the first attempt and one patient died because of uncontrollable sepsis despite prompt operative treatment. Seven patients had unsuccessful endoscopic derotation and were operated on. On two patients with gangrenous sigmoid, Hartmann's procedure was performed. In five patients with viable colon, a sigmoid resection and primary anastomosis was carried out. Three patients had a lavage "on table" prior to anastomosis, while in the remaining 2 patients a diverting stoma was performed according to the procedure of the first author. Ten patients were operated on during their first hospital stay (3 to 8 d after the deflation). All patients had viable colon; 7 patients had a sigmoid resection and primary anastomosis, 2 patients had sigmoidopexy and one patient underwent a near-total colectomy. Two patients (sigmoidectomy-sigmoidopexy) had recurrences of volvulus 43 and 28 mo after the initial surgery. Among 15 patients who were discharged from the hospital after non-operative deflation, 3 patients were lost to follow-up. Of the remaining 12 patients, 5 had a recurrence of volvulus at a time in between 23 d and 14 mo. All the five patients had been operated on and in four a gangrenous sigmoid was found. Three patients died during the 30 d postoperative course. The remaining seven patients were admitted to our department for elective surgery. In these patients, 2 subtotal colectomies, 3 sigmoid resections and 2 sigmoidopexies were carried out. One patient with subtotal colectomy died. Taken together of the results, it is evident that after 17 elective operations we had only one death (5.9%), whereas after 15 emergency operations 6 patients died, which means a mortality rate of 40%.
CONCLUSION
Although sigmoid volvulus causing intestinal obstruction is frequently successfully encountered by endoscopic decompression, however, the principal therapy of this condition is surgery. Only occasionally in patients with advanced age, lack of bowel symptoms and multiple co-morbidities might surgical repair not be considered.
Topics: Age Factors; Aged; Aged, 80 and over; Colon, Sigmoid; Endoscopy, Gastrointestinal; Female; Humans; Intestinal Obstruction; Intestinal Volvulus; Male; Middle Aged; Retrospective Studies
PubMed: 17352024
DOI: 10.3748/wjg.v13.i6.921 -
Journal of Medical Case Reports Oct 2021Gallbladder volvulus is a rare pathology first reported by Wendel in 1898. Although the main pathological process associated with gallbladder volvulus is not known,...
BACKGROUND
Gallbladder volvulus is a rare pathology first reported by Wendel in 1898. Although the main pathological process associated with gallbladder volvulus is not known, there is clinical evidence suggesting that lack of gallbladder adhesions to the liver leads to an eventual twisting around the cystic bile duct (a process that seems to favor older female populations).
CASE PRESENTATION
In this report, an 81-year-old Caucasian elderly female presented to the emergency department with acute/severe right upper quadrant pain, which was also accompanied by an elevated leukocyte count. Relevant imaging showed a distended gallbladder with gallbladder wall thickening and a dilated common bile duct. The patient was subsequently admitted to the hospital for acute cholecystitis and scheduled for surgery the next day. Upon laparoscopic surgery, the gallbladder was black and gangrenous with no visible adhesions to the liver. Further inspection demonstrated that the gallbladder had twisted clockwise around the cystic bile duct.
CONCLUSIONS
While many previous cases have been reported since Wendel, further case studies are nevertheless important to help guide proper clinic evaluation and pinpoint the potential for a gallbladder volvulus.
Topics: Abdominal Pain; Aged; Aged, 80 and over; Female; Gallbladder Diseases; Humans; Intestinal Volvulus; Torsion Abnormality
PubMed: 34625099
DOI: 10.1186/s13256-021-03115-7 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Mar 2022Sigmoid volvulus (SV), the wrapping of the sigmoid colon around itself, is a rare intestinal obstruction form world-wide. For this reason, the physiopathology of SV,...
BACKGROUND
Sigmoid volvulus (SV), the wrapping of the sigmoid colon around itself, is a rare intestinal obstruction form world-wide. For this reason, the physiopathology of SV, particularly the precipitating factors, are not clearly identified. The aim of this study is to evaluate the precipitating factors in SV.
METHODS
The clinical records of consecutive 416 patients with SV were reviewed prospectively from January 1986 to July 2020. As a control, the records of consecutive 100 patients with non-volvulus intestinal obstruction were reviewed prospectively in the past 24 months. The premorbid symptoms including acute diarrhea, sudden and excessive body motions, overeating after a prolonged starvation, coughing spell, and labor was evaluated.
RESULTS
Among the premorbid symptoms, 1-5-day interval of diarrhea (42 patients, 10.1%, p<0.05), harvesting activation (35 patients, 8.4%, p<0.05), and overeating after Ramadan fasting (31 patients, 7.5%, p<0.05) were found to be statistically significant precipitating factors in SV.
CONCLUSION
Although there are few studies about the precipitating factors of SV in the literature, increased bowel motility, excessive body motions, and overeating following a prolonged starvation look like the precipitating factors in the development of SV.
Topics: Diarrhea; Humans; Hyperphagia; Intestinal Obstruction; Intestinal Volvulus; Sigmoid Diseases
PubMed: 35485550
DOI: 10.14744/tjtes.2020.03762 -
The Canadian Veterinary Journal = La... Mar 2024To describe the findings, treatment, and outcome of small intestinal volvulus (SIV) in 47 cows.
OBJECTIVE
To describe the findings, treatment, and outcome of small intestinal volvulus (SIV) in 47 cows.
ANIMALS AND PROCEDURE
Retrospective analysis of medical records. Comparison of the findings for 18 surviving and 29 non-surviving cows.
RESULTS
The most common abnormal vital signs were tachycardia (68.0%), tachypnea (59.6%), and decreased rectal temperature (51.1%). Signs of colic occurred in 66.0% of cows in the study. Rumen motility was reduced or absent in 93.6% of cows, and intestinal motility in 76.6%. Clinical signs on ballottement and/or percussion and simultaneous auscultation were positive on the right side in 78.7% of cows. Transrectal examination showed dilated small intestines in 48.9% of cows. The rectum contained little or no feces in 93.6% of cows. The principal laboratory abnormalities were hypocalcemia (74.1%), hypokalemia (73.8%), azotemia (62.8%), hypermagnesemia (61.6%), and hemoconcentration (60.0%). The principal ultrasonographic findings were dilated small intestines (87.1%) and reduced or absent small intestinal motility (85.2%). Forty-one of the 47 cows underwent right flank laparotomy and the SIV was reduced in 21 cows. When comparing the clinical and laboratory findings of 18 surviving and 29 non-surviving cows, the groups differed significantly with respect to severely abnormal general condition (16.7 37.9%), rumen stasis (22.2 79.3%), intestinal atony (16.7 48.3%), serum urea concentration (6.5 9.8 mmol/L), and serum magnesium concentration (0.98 1.30 mmol/L). In summary, 38.3% of the cows were discharged and 61.7% were euthanized before, during, or after surgery.
CONCLUSION AND CLINICAL RELEVANCE
An acute course of disease, little or no feces in the rectum, and dilated small intestines were characteristic of SIV in this study population.
Topics: Humans; Female; Cattle; Animals; Pregnancy; Intestinal Volvulus; Retrospective Studies; Intestine, Small; Rectum; Feces; Magnesium; Cattle Diseases
PubMed: 38434172
DOI: No ID Found -
Pediatric Radiology Nov 2004Malrotation with volvulus is one of the true surgical emergencies of childhood. Prompt radiological diagnosis is often paramount to achieving a good outcome. An... (Review)
Review
Malrotation with volvulus is one of the true surgical emergencies of childhood. Prompt radiological diagnosis is often paramount to achieving a good outcome. An understanding of the normal and anomalous development of the midgut provides a basis for understanding the pathophysiology and the clinical presentation of malrotation and malrotation complicated by volvulus. In this essay, the radiologic findings of malrotation and volvulus are reviewed and illustrated with particular attention to the child with equivocal imaging findings.
Topics: Duodenum; Humans; Infant; Infant, Newborn; Intestinal Volvulus; Intestines; Jejunum; Magnetic Resonance Imaging; Prenatal Diagnosis; Radiography
PubMed: 15378215
DOI: 10.1007/s00247-004-1279-4 -
Pediatric Radiology Dec 2010
Topics: Humans; Infant, Newborn; Intestinal Obstruction; Intestinal Volvulus; Intestine, Small; Meconium; Peritonitis; Radiography
PubMed: 20574652
DOI: 10.1007/s00247-010-1748-x -
Asian Journal of Surgery Jan 2022Sigmoid volvulus is the most common type of volvulus. Its epidemiological features, as well as its management, differ between developed and developing countries. This...
BACKGROUND/OBJECTIVE
Sigmoid volvulus is the most common type of volvulus. Its epidemiological features, as well as its management, differ between developed and developing countries. This work aims to analyze the epidemiological features thus allowing to compare them to the rest of the "volvulus belt'' and assess the surgical management of sigmoid volvulus in Tunisia.
METHOD
This is a retrospective review of 64 patients with sigmoid volvulus treated in the General Surgery department of Jendouba Hospital. January 2005-December 2019.
RESULTS
64 patients were treated for acute sigmoid volvulus. The sex ratio male to female ratio was 5.4/1 with male predominance. 5.4:1 (54 males to 10 females). The mean age was 62 years. The classic triad of intestinal occlusion was reported in 56 patients. The mean duration of symptoms was 4.2 days. An accurate preoperative diagnosis was made in 58 cases. Forty patients had a viable bowel obstruction, and all of them had a resection and primary anastomosis. Sixteen patients had a gangrenous bowel obstruction, of which 6 patients had resection-primary anastomosis, and 10 had Hartmann's procedure. Out of the total five deaths reported, there were only two among patients who had resection-primary anastomosis for gangrenous bowel obstruction. The most common postoperative complication was wound infections in 5 cases. The median length of hospital stay following surgery was 8 days. No recurrences of volvulus after a median follow-up of 11 months.
CONCLUSIONS
Although Tunisia belongs to the volvulus belt, the epidemiologic features of sigmoid volvulus tend rather be similar to those of developed countries. The use of primary surgery, if no endoscopy is performed, is a good alternative. For patients who have contraindications for endoscopic treatment, surgical treatment is the only option.
Topics: Colostomy; Female; Humans; Intestinal Obstruction; Intestinal Volvulus; Male; Middle Aged; Retrospective Studies; Sigmoid Diseases
PubMed: 33895046
DOI: 10.1016/j.asjsur.2021.04.004 -
BMJ Case Reports Mar 2021Caecal volvulus is an infrequent cause of acute surgical abdomen, where an abnormally mobile cecum twists on its own axis. It can lead to the development of closed-loop...
Caecal volvulus is an infrequent cause of acute surgical abdomen, where an abnormally mobile cecum twists on its own axis. It can lead to the development of closed-loop obstruction, small bowel ischaemia and perforation. Early recognition and prompt treatment is key; however, due to the rarity of this pathology, it is seldom listed as a differential diagnosis. Here, we present a single-centre case series of two patients presenting with caecal volvulus to an Emergency Surgery Unit at a University Hospital.
Topics: Cecal Diseases; Humans; Intestinal Obstruction; Intestinal Volvulus; Ischemia
PubMed: 33692042
DOI: 10.1136/bcr-2020-237165 -
Veterinary Pathology Jul 2013Intestinal volvulus was recognized as the cause of death in 18 cetaceans, including 8 species of toothed whales (suborder Odontoceti). Cases originated from 11...
Intestinal volvulus was recognized as the cause of death in 18 cetaceans, including 8 species of toothed whales (suborder Odontoceti). Cases originated from 11 institutions from around the world and included both captive (n = 9) and free-ranging (n = 9) animals. When the clinical history was available (n = 9), animals consistently demonstrated acute dullness 1 to 5 days prior to death. In 3 of these animals (33%), there was a history of chronic gastrointestinal illness. The pathological findings were similar to those described in other animal species and humans, and consisted of intestinal volvulus and a well-demarcated segment of distended, congested, and edematous intestine with gas and bloody fluid contents. Associated lesions included congested and edematous mesentery and mesenteric lymph nodes, and often serofibrinous or hemorrhagic abdominal effusion. The volvulus involved the cranial part of the intestines in 85% (11 of 13). Potential predisposing causes were recognized in most cases (13 of 18, 72%) but were variable. Further studies investigating predisposing factors are necessary to help prevent occurrence and enhance early clinical diagnosis and management of the condition.
Topics: Animals; Anorexia; Ascitic Fluid; Asia; Australia; Causality; Cetacea; Chronic Disease; Enteritis; Europe; Female; Incidence; Intestinal Volvulus; Intestines; Lymph Nodes; Male; Mesentery; North America
PubMed: 23150643
DOI: 10.1177/0300985812465327 -
Radiologia 2015Gastrointestinal volvuli cause processes that manifest as acute abdomen. Volvuli are important not because they are common, but rather because their possible... (Review)
Review
Gastrointestinal volvuli cause processes that manifest as acute abdomen. Volvuli are important not because they are common, but rather because their possible complications can be severe. All types of volvuli share a common pathophysiology, which consists of intestinal obstruction in a closed loop that results in ischemia. The clinical manifestations are nonspecific, so radiologists play a very important role in the early identification of the most common signs of torsion. These include the "bird's beak sign", the "whirlpool sign", and signs of potentially reversible or irreversible ischemia. The treatment of choice in most cases is surgery, either to correct the torsion and save the organ or to resect it if it is necrotic.
Topics: Humans; Intestinal Volvulus; Multidetector Computed Tomography; Radiography; Stomach Volvulus
PubMed: 24703987
DOI: 10.1016/j.rx.2013.09.008