A study of large-bowel volvulus in urban Australia.

Abstract

BACKGROUND:

Large-bowel volvulus is a rare cause of bowel obstruction in the industrialized world. We analyzed the presentation and outcome of 49 patients at the Princess Alexandra Hospital, Brisbane, Australia, who received a diagnosis of colonic volvulus from 1991 to 2001.

METHODS:

A retrospective chart study was carried out.

RESULTS:

Twenty-nine patients had sigmoid volvulus (59%), 19 patients had cecal volvulus (39%) and 1 patient had a transverse colon volvulus (2%). The diagnosis of sigmoid volvulus was made accurately on plain abdominal radiography or contrast enema in 90% of cases (n = 26), compared with only 42% of cases (n = 8) of cecal volvulus. Twenty-two patients with sigmoid volvulus were treated initially with endoscopic decompression. The success rate was 64% (n = 14). There was a high early recurrence rate of sigmoid volvulus for those treated by endoscopic decompression alone (43%) during a mean period of 32 days. Of the 14 patients with cecal volvulus who were treated with right hemicolectomy, 12 had primary anastomosis and 2 had end ileostomy with mucous fistula formation. There was no anastomotic leak following right hemicolectomy with primary anastomosis, even though 6 of these patients had an ischemic cecum.

CONCLUSIONS:

Endoscopic decompression of the sigmoid volvulus was safe and effective as an initial treatment but has a high early recurrence rate. Any patient who is fit enough to undergo operation should have a definitive procedure during the same admission to avoid recurrence. Cecal volvulus is associated with a higher incidence of gangrene and is treated effectively by right hemicolectomy with or without anastomosis. The need for swift operative intervention is emphasized.

• Authors: Kevin C N Lau, Brian J Miller, David J Schache, Jon R Cohen
• Journal: Canadian journal of surgery. Journal canadien de chirurgie (Can J Surg) Vol. 49 Issue 3 Pg. 203-7 (Jun 2006) ISSN: 0008-428X [Print] Canada
• PMID: 16749982 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Aged, 80 and over
• Australia (epidemiology)
• Colonoscopy
• Decompression, Surgical (methods)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Intestinal Volvulus (diagnostic imaging, epidemiology, surgery)
• Intestine, Large
• Male
• Middle Aged
• Radiography, Abdominal
• Retrospective Studies