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Experience with colonic volvulus.

J D Friedman1, M D Odland, M P Bubrick

  • 1Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota 55415.

Diseases of the Colon and Rectum
|May 1, 1989
PubMed
Summary
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Endoscopic decompression is effective for sigmoid volvulus but not cecal volvulus. Both conditions require assessment of colonic motility for definitive treatment, impacting patient outcomes and recurrence rates.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Diagnostic Imaging

Background:

  • Colonic volvulus, a condition where the colon twists on itself, presents diagnostic and therapeutic challenges.
  • Sigmoid and cecal volvulus are the most common forms, each with distinct clinical behaviors and treatment considerations.

Purpose of the Study:

  • To evaluate the efficacy of different treatment modalities for sigmoid and cecal volvulus.
  • To assess the role of endoscopic decompression and surgical interventions.
  • To investigate the long-term implications of colonic motility disturbances in patients with volvulus.

Main Methods:

  • Retrospective review of 58 cases of colonic volvulus (30 sigmoid, 27 cecal, 1 transverse).
  • Analysis of outcomes for decompression procedures (endoscopic and contrast enema) and surgical interventions.

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  • Evaluation of recurrence rates and colonic motility disorders in follow-up.

    • Main Results:

    • Endoscopic decompression was successful in 81% of sigmoid volvulus cases, with a 13% mortality rate after surgery.
    • Endoscopic decompression was unsuccessful in cecal volvulus; surgical intervention had a 15% mortality rate.
    • Chronic large-bowel motility disturbances were observed in 45% of sigmoid volvulus surgical survivors and 14% of cecal volvulus patients.

    Conclusions:

    • Endoscopic decompression is a valuable treatment for sigmoid volvulus.
    • Endoscopic decompression is not recommended for cecal volvulus.
    • Assessment of colonic motility is crucial for the definitive management of both sigmoid and cecal volvulus to prevent recurrence and improve outcomes.