Preoperative Colonoscopic Derotation Is Beneficial in Acute Colonic Volvulus

Abstract

Aims: Analysis of preoperative and operative management of acute colonic volvulus and development of treatment guidelines in a region of low incidence. Methods: A study of 42 consecutive patients operated for acute colonic volvulus between 1970 and 2000. Results: There were 20 patients with sigmoid volvulus, 21 with cecal volvulus and 1 with volvulus of the transverse colon. All patients presented as emergencies. The correct preoperative diagnosis was possible for sigmoid volvulus in 95% (19/20) of cases and for cecal volvulus in 67% (14/21). Preoperative colonoscopic volvulus derotation was attempted in 19 patients and successfully completed in 9 patients (47%). The success rates for preoperative colonoscopic derotation were 58 (7/12) and 33% (2/6) for sigmoid and cecal volvulus, respectively. Thirty-four patients (81%) underwent colon resections, 26 times as a single-stage procedure, and 8 patients (19%) underwent non-resectional operative techniques. Overall surgical morbidity was 24%, the reoperation rate 9.5% and mortality 12% (5/42). The subgroup of 9 patients with successful non-operative volvulus derotation, however, underwent semi-elective single-stage colonic resection without surgical morbidity or mortality. There were no recurrences during a median follow-up period of 9.5 years. Conclusion: In the absence of clinical, laboratory or radiological signs of bowel necrosis or perforation, colonoscopic volvulus derotation is recommended in all cases of acute colonic volvulus, followed by semi-elective single-stage colonic resection.

Is laparotomy the unavoidable step to diagnose caecal volvulus?

“…The 'coffee bean' sign refers to the rounded focal collection of air-distended bowel with haustral creases visualised in the left upper quadrant or anywhere within the abdominal cavity. [3][4][5][6][7][8][9][10][11][12] The 'bird beaks' are images correlating with the progressively tapering efferent and afferent bowel loops terminating at the site of torsion. 3 More specific for volvulus is the 'whirl sign', in which the whirl is composed of spiralled loops of collapsed caecum and sigmoid colon.…”

Eosinophilic Colitis

“…Plain abdominal x-ray is diagnostic in 62% of cases (coffee bean deformity). 4 Preoperative colonoscopic derotation can be achieved in the absence of peritonitis, and the success rate has been reported as 12.5%. 4 If unsuccessful, definitive treatment with colonic resection and primary anastomosis is the treatment of choice.…”

“…4 Preoperative colonoscopic derotation can be achieved in the absence of peritonitis, and the success rate has been reported as 12.5%. 4 If unsuccessful, definitive treatment with colonic resection and primary anastomosis is the treatment of choice. Colonic volvulus has been reported in celiac sprue, 5 and Clostridium difficile infection, 6 suggesting acute mucosal inflammation being the contributory factor in the development of a volvulus.…”

Co-existence of Cecal Volvulus with Situs Inversus Totalis: A Case Report

“…However it has a success rate about %12.5 alone. 13 In our case, because of the uncertainty about intestinal necrosis, low success rate and high recurrence rate, we did not choose cecostomy, cecopexy or tube cecostomy. In conclusion, adult presentation of situs inversus abdominus with cecal volvulus is a difficult diagnosis because of the rare incidence of the disorder.…”