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Related Experiment Videos

Volvulus of the colon.

C Theuer1, W G Cheadle

  • 1Department of Surgery, University of Louisville, School of Medicine, Kentucky 40292.

The American Surgeon
|March 1, 1991
PubMed
Summary

Colonic volvulus management varies by type. Nonoperative decompression is effective for sigmoid volvulus, while cecal volvulus often requires surgery. Elective surgery for sigmoid volvulus is best after recurrences.

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Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology
  • Colorectal Surgery

Background:

  • Colonic volvulus is a significant cause of bowel obstruction.
  • Risk factors include dementia, immobility, and constipating medications.

Purpose of the Study:

  • To review outcomes of colonic volvulus treatment.
  • To compare nonoperative and operative management strategies.
  • To identify optimal timing for surgical intervention in sigmoid volvulus.

Main Methods:

  • Retrospective chart review of 45 colonic volvulus patients (1983-1988).
  • Analysis of cecal and sigmoid volvulus cases separately.
  • Comparison of outcomes based on treatment modality (nonoperative vs. operative) and urgency.

Main Results:

  • Nonoperative decompression succeeded in 26/29 sigmoid volvulus patients but only 3/9 cecal volvulus patients.
  • Cecal volvulus patients (16/17) required surgery; cecopexy alone had no mortality or recurrence.
  • Sigmoid volvulus: 1/3 had recurrences; 14/29 underwent surgery with 50% mortality; nonoperative treatment had zero mortality.

Conclusions:

  • Nonoperative decompression is a safe and effective initial treatment for sigmoid volvulus, even for recurrences.
  • Elective surgery for sigmoid volvulus should be considered after failed nonoperative attempts or recurrences.
  • Cecal volvulus management requires prompt surgical intervention, with cecopexy showing better outcomes than tube cecostomy.

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