Management of acute sigmoid volvulus: short‐ and long‐term results

Bruzzi, Matthieu; Lefèvre, Jérémie H.; Desaint, B.; Nion–Larmurier, Isabelle; Bennis, Malika; Chafaı̈, Najim; Tiret, Emmanuel; Parc, Yann

doi:10.1111/codi.12959

Cited by 52 publications

(62 citation statements)

References 25 publications

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“…However, effective, long-term prevention typically involves the insertion of two PEC tubes, ideally at each end of the sigmoid colon to reduce mesenteric mobility. This is usually well tolerated with good outcomes [7, 8, 10]. Indeed, in a case where one of two PEC tubes was removed, the patient experienced volvulus recurrence and a second tube had to be re-sited [10].…”

Section: Discussionmentioning

confidence: 99%

“…Several case reports suggest that keeping the PEC tube in situ prevents volvulus recurrence [8, 10] and, if removed, symptomatic relapse is likely [7, 8, 10]. Infection [9] or patient request [10] often necessitates early PEC removal at a known risk of recurrence [9].…”

Section: Discussionmentioning

confidence: 99%

“…One study (of six patients) reported that the mean number of episodes before PEC placement was 3.5 [7], but no larger trials have been conducted. Typically, intervention is offered on a case-by-case basis with emphasis on patient preference in those unsuitable for operative intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Non-operative options include: endoscopic T-fastener fixation, tube sigmoidostomy, colon extraperitonealization, mesocoloplasty, sigmoid plication, Ladd's procedure or percutaneous endoscopic colostomy (PEC) tube placement [4]. Although no trials have directly compared these various options, PEC insertion is usually preferred due to its lower risk profile [7, 8]. The most common complication following PEC insertion is infection—occurring in up to 77% of patients—which may necessitate PEC removal [9].…”

Section: Introductionmentioning

confidence: 99%

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Conservative management of migrated percutaneous endoscopic colostomy tube

et al. 2017

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A 68-year-old male nursing home resident presented following dislodgement of a percutaneous endoscopic colostomy (PEC) tube originally sited to prevent recurrent sigmoid volvulus. Computed tomography demonstrated tube migration into the lumen of the recto-sigmoid junction, where it remained for 12 days before passing spontaneously. During this period, the patient remained asymptomatic; the residual colocutaneous fistula functioned as a decompressive valve. Originally, the patient was due to be discharged with early flexible sigmoidoscopy follow-up. However, complex social issues delayed discharge. During his admission, a second PEC tube was successfully inserted next to the previous colostomy site without complication. This is an unusual case and no similar episodes of asymptomatic PEC migration have been reported. We demonstrate that such cases may be offered an appropriate trial of conservative management. Here, we describe our experience and critically appraise the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Conservative management of migrated percutaneous endoscopic colostomy tube

et al. 2017

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“…Since those patients also often display a high risk for morbidity and mortality in the perioperative setting, sigmoid resection often cannot be conducted [2, 8]. In this case, percutaneous endoscopic colopexy (PEC) might be a valuable option [9]. …”

Section: Introductionmentioning

confidence: 99%

A Symptomatic Coffee Bean: Acute Sigmoid Volvulus

Scharl

Biedermann

2017

Case Rep Gastroenterol

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An acute sigmoid volvulus is due to the torsion of the sigmoid colon around its mesenteric axis. It mainly occurs in elderly patients and represents an abdominal emergency requiring urgent treatment. A 53-year-old male patient with severe craniocerebral injury and traumatic subarachnoidal bleeding 3 weeks prior presented on the ward with distended abdomen without abdominal pain, muscular defense, or resistances. He featured large volume diarrhea within the last few hours without signs of bleeding. A plain abdominal X-ray demonstrated a coffee bean sign indicating a sigmoid volvulus. A consequent CT scan of the abdomen revealed a deep outlet obstruction with massively dilated, elongated and twisted loop of the sigmoid colon and no signs of perforation. We performed emergency colonoscopy under the assumption of an acute sigmoid volvulus. After careful insertion of the endoscope completely refraining from insufflation of air or CO₂, endoscopic reposition of the sigma could be achieved and a colonic drainage was placed over an inserted guide wire up to the proximal transverse colon. No relapse occurred and a diagnostic colonoscopy after 4 weeks revealed no tumor or polyps. Our report describes a classic case of acute sigmoid volvulus and undermines the potential of colonoscopy as conservative primary treatment of choice.

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