1. Volvulus
嘉義長庚醫院
大腸直腸外科
葉重宏

2. Colon twists on its own mesenteric axis
venous congestion and infarction
Gangrene
Arterial supply comprised
Ischemia

3. Distribution
Sigmoid colon : Most common
Cecum
T-Colon
Splenic flexure

4. Sigmoid Volvulus Prevalence : 3% ~ 30% in large bowel obstruction
Country
Age

5. Pathogenesis The pathogenesis is obscure Chronic constipation
High fiber diet
Chronic medical or psychiatric problem
Precipitating factor
: pregnancy, abdominal surgery

6. Symptoms and Signs Colicky abdominal pain Constipation
Failure to pass flatus
Abdominal distension
Nausea
Vomiting

7. Diagnosis Supine abdominal X-ray -- Bent inner tire sign
BAE: complete retrograde obstruction
-- Bird’s beak sign
Colonoscopy or sigmoidoscopy

8. Treatment Non-operative procedure Successful rate : 70 % ~ 90 %
Rigid sigmoidoscopy with rectal tube decompression : left in place for 48 hours
Colonoscopy
Recurrent rate : 43% ~ 57 % in 2 years

9. Operative Treatment Indication Procedure Unsuccessful reduction
Nonviability of colon
Elective surgery after reduction
Procedure
Sigmoid colectomy and anastomosis
Hartmann’s procedure
Detorsion and sigmoidpexy -- avoid

10. Mortality Risk factor 8 % -- elective surgery 28 % -- emergent surgery
Old age
Emergent surgery
Nonviable colon
Previous history of volvulus

11. Cecal Volvulus Prevalence : 25 % ~ 30 % of all volvulus
Precipitating factor
Distal colon obstruction Colonic atony
Pregnancy Prolong constipation
Prior abdominal surgery Mesenteric adenitis
Congenital band Jogging
Violent cough
Intermittent positive pressure breathing
Meteorism in unpressurized air travel

12. S/S Diagnosis -- Acute intestinal obstruction Pain ABD :
--- Coffee bean shape
BAE :
--- Bird’s beak deformity of cecum

13. Treatment Surgery Colonoscopy is not recommended Detorsion
Detorsion and cecopexy
Cecostomy
R’t hemicolectomy

14. Volvulus and Pregnancy
Prevalence of intestinal obstruction
--- 3 / 100,000 pregnancies
25 % was caused by volvulus