Abstract
Flexible fiberoptic gastrointestinal endoscopy has greatly simplified the diagnosis and treatment of colonic volvulus. The management of 39 patients with colonic volvulus treated over 9 years was reviewed. Five per cent were treated with rectal tube decompression alone, 23% were treated with either sigmoidoscopic or colonoscopic reduction, and 26% were treated exclusively with operation. Endoscopic reduction was attempted in nearly half of the patients in preparation for operation. Recurrent volvulus occurred in 57% of patients initially treated with endoscopic reduction alone. Sigmoidoscopic examination did not confirm the diagnosis in 24% of instances in which it was used, although colonoscopy was always diagnostic. The overall mortality rate was 8%, but increased to 25% in patients with gangrene of the colon. Three patients who later proved to have gangrene of the colon had a normal initial sigmoidoscopic examination. Two of these patients died of intra-abdominal sepsis from a perforated colon. In five patients an accurate endoscopic diagnosis of gangrene prompted immediate exploration. None of these patients died. Endoscopy is a safe and effective diagnostic tool for the initial evaluation of patients with suspected colon volvulus. In addition, endoscopy may result in therapeutic decompression and may provide visual assessment of the viability of the bowel mucosa, thus assisting in the timing of appropriate operative treatment.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Anderson M. J., Sr, Okike N., Spencer R. J. The colonoscope in cecal volvulus: report of three cases. Dis Colon Rectum. 1978 Jan-Feb;21(1):71–74. doi: 10.1007/BF02586552. [DOI] [PubMed] [Google Scholar]
- Arnold G. J., Nance F. C. Volvulus of the sigmoid colon. Ann Surg. 1973 May;177(5):527–537. doi: 10.1097/00000658-197305000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ballantyne G. H., Brandner M. D., Beart R. W., Jr, Ilstrup D. M. Volvulus of the colon. Incidence and mortality. Ann Surg. 1985 Jul;202(1):83–92. doi: 10.1097/00000658-198507000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ballantyne G. H. Review of sigmoid volvulus: history and results of treatment. Dis Colon Rectum. 1982 Jul-Aug;25(5):494–501. doi: 10.1007/BF02553666. [DOI] [PubMed] [Google Scholar]
- Ballantyne G. H. Volvulus of the splenic flexure: report of a case and review of the literature. Dis Colon Rectum. 1981 Nov-Dec;24(8):630–632. doi: 10.1007/BF02605762. [DOI] [PubMed] [Google Scholar]
- Ballantyne G. H. Volvulus of the splenic flexure: report of a case and review of the literature. Dis Colon Rectum. 1981 Nov-Dec;24(8):630–632. doi: 10.1007/BF02605762. [DOI] [PubMed] [Google Scholar]
- DRAPANAS T., STEWART J. D. Acute sigmoid volvulus. Concepts in surgical treatment. Am J Surg. 1961 Jan;101:70–77. doi: 10.1016/0002-9610(61)90655-9. [DOI] [PubMed] [Google Scholar]
- Ghazi A., Shinya H., Wolfe W. I. Treatment of volvulus of the colon by colonoscopy. Ann Surg. 1976 Mar;183(3):263–265. doi: 10.1097/00000658-197603000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hines J. R., Geurkink R. E., Bass R. T. Recurrence and mortality rates in sigmoid volvulus. Surg Gynecol Obstet. 1967 Mar;124(3):567–570. [PubMed] [Google Scholar]
- O'Mara C. S., Wilson TH Jr Stonesifer G. L., Stonesifer G. L., Cameron J. L. Cecal volvulus: analysis of 50 patients with long-term follow-up. Ann Surg. 1979 Jun;189(6):724–731. doi: 10.1097/00000658-197906000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Starling J. R. Initial treatment of sigmoid volvulous by colonoscopy. Ann Surg. 1979 Jul;190(1):36–39. doi: 10.1097/00000658-197907000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Strodel W. E., Nostrant T. T., Eckhauser F. E., Dent T. L. Therapeutic and diagnostic colonoscopy in nonobstructive colonic dilatation. Ann Surg. 1983 Apr;197(4):416–421. doi: 10.1097/00000658-198304000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]