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Related Experiment Videos

Colonic volvulus. Etiology and management.

I T Jones1, V W Fazio

  • 1Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio.

Digestive Diseases (Basel, Switzerland)
|January 1, 1989
PubMed
Summary

Colonic volvulus, a cause of large bowel obstruction, is managed effectively with nonoperative tube decompression for sigmoid cases. This allows for elective surgery, improving patient outcomes and reducing mortality associated with emergency procedures.

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Abdominal Imaging

Background:

  • Colonic volvulus is a significant cause of large bowel obstruction, particularly in specific global regions.
  • While often idiopathic with potential anatomical predispositions, some cases are secondary to conditions like Chagas' disease.
  • Sigmoid and right colon volvulus are most common, while transverse colon and splenic flexure involvement are rare.

Purpose of the Study:

  • To review the epidemiology, pathophysiology, and management of colonic volvulus.
  • To highlight the advancements in treating sigmoid volvulus, particularly nonoperative decompression.
  • To outline surgical options for different types of colonic volvulus and bowel viability.

Main Methods:

  • Review of existing literature on colonic volvulus.
  • Analysis of epidemiological data and clinical outcomes.
  • Discussion of diagnostic and therapeutic strategies.

Main Results:

  • Nonoperative tube decompression for sigmoid volvulus has significantly improved management, enabling elective surgery.
  • Emergency surgery remains necessary for a subset of patients, including those with failed decompression or signs of gangrene.
  • Surgical options include resection and colostomy for sigmoid volvulus, and detorsion, cecopexy, or tube cecostomy for cecal volvulus.

Conclusions:

  • Tube decompression represents a major advancement in sigmoid volvulus management, reducing the need for emergency surgery.
  • Treatment strategies for colonic volvulus depend on the affected segment, presence of complications like gangrene, and patient condition.
  • Optimal management aims to reduce mortality and morbidity through timely and appropriate interventions.

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