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 Procedure Unsuccessful reduction Nonviability of colon Elective surgery after reduction Procedure Sigmoid colectomy and anastomosis Hartmann’s procedure Detorsion and sigmoidpexy -- avoid

Mortality Risk factor 8 % -- elective surgery 28 % -- emergent surgery 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 Diagnosis -- Acute intestinal obstruction Pain ABD : --- Coffee bean shape BAE : --- Bird’s beak deformity of cecum

Treatment Surgery Colonoscopy is not recommended Detorsion Detorsion and cecopexy Cecostomy R’t hemicolectomy

Volvulus and Pregnancy Prevalence of intestinal obstruction --- 3 / 100,000 pregnancies 25 % was caused by volvulus