Volvulus surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Surgery is the mainstay of treatment for volvulus. Endoscopic and nasogastric decompression may be used initially in an attempt to detorse the volvulus when feasible. Subsequently, an open procedure or laparotomy may follow to enter the abdomen, untwist the bowels and restore the blood supply. Necrotic bowel is either resected and re-anastomosed with the remaining bowel or is connected externally by colostomy or ileostomy.
Preoperative decompression
- Preoperative decompresssion is recommended whenever feasible to reduce mortality, morbidity and to convert an emergency procedure into a semi-urgent procedure. However, decompression is rarely successful with cecal volvulus and should not be attempted.[1][2][3][4][5][6]
- Sigmoid volvulus decompression:
- Sigmoidoscopy may be utilized to reduce sigmoid volvulus.
- Flexible sigmoidoscopy has the advantage of being able to assess the viability of the colon.
- A rectal tube may be placed to lessen colonic distension and reduce the chance of recurrent volvulus.
- Gastric volvulus decompression:
- Nasogastric decompression is performed to reduce gastric volvulus as the primary treatment.
- Percutaneous endoscopic gastrostomy (PEG) tubes can be placed to fix the stomach into position after successful reduction.
- Barium enema has also been used in the past for reduction, but carries a higher risk of perforation.
- Contraindications of decompression include:
Surgery
- Surgery is the mainstay of treatment for volvulus.[7][8][9][10][11][12][13][14][15]
- The aim of surgery is to reduce the volvulus and to prevent volvulus recurrence.
- Laparoscopy or an open procedure may be elected depending on the degree of bowel distension.
- Gastric volvulus can be reduced via a laparoscopic or an open procedure, if nasogastric decompression is not successful. However, an open procedure is usually performed.
- Sigmoid volvulus is reduced via laparotomy through Hartmann's procedure (resection with primary anastomosis).
- Cecal volvulus is reduced via laparoscopy or an open procedure, decompression should not be attempted:
- If the bowel is compromised (ischemic, necrotic, or perforated) then the volvulus must not be detorsed (untwisted) to avoid reperfusion injury and primary ileocolic anastomosis is carried out.
- When the patient is stable and the bowel is not compromised, the bowel is detorsed then a right colectomy or an ileocolic resection is performed. Detorsion alone is associated with a high failure rate of perfusion.
- When the patient is not stable and the bowel is not compromised, cecopexy can be performed alone or in conjunction with cecostomy tube placement and/or appendectomy after detorsion.
Contraindications
- Once surgery is indicated, there are no contraindications.
- However, decompression may be contraindicated when the bowel is compromised:
References
- ↑ Mangiante EC, Croce MA, Fabian TC, Moore OF, Britt LG (1989). "Sigmoid volvulus. A four-decade experience". Am Surg. 55 (1): 41–4. PMID 2643910.
- ↑ Anderson JR, Lee D (1981). "The management of acute sigmoid volvulus". Br J Surg. 68 (2): 117–20. PMID 7459614.
- ↑ Lee SY, Bhaduri M (2013). "Cecal volvulus". CMAJ. 185 (8): 684. doi:10.1503/cmaj.120651. PMC 3652939. PMID 23027907.
- ↑ Godshall D, Mossallam U, Rosenbaum R (1999). "Gastric volvulus: case report and review of the literature". J Emerg Med. 17 (5): 837–40. PMID 10499699.
- ↑ Mangray H, Latchmanan NP, Govindasamy V, Ghimenton F (2008). "Grey's Ghimenton gastropexy: an anatomic make-up for management of gastric volvulus". J. Am. Coll. Surg. 206 (1): 195–8. doi:10.1016/j.jamcollsurg.2007.05.012. PMID 18155589.
- ↑ Kotobi H, Auber F, Otta E, Meyer N, Audry G, Hélardot PG (2005). "Acute mesenteroaxial gastric volvulus and congenital diaphragmatic hernia". Pediatr. Surg. Int. 21 (8): 674–6. doi:10.1007/s00383-005-1437-2. PMID 16007427.
- ↑ Ballantyne GH, Brandner MD, Beart RW, Ilstrup DM (1985). "Volvulus of the colon. Incidence and mortality". Ann. Surg. 202 (1): 83–92. PMC 1250842. PMID 4015215.
- ↑ Oren D, Atamanalp SS, Aydinli B, Yildirgan MI, Başoğlu M, Polat KY, Onbaş O (2007). "An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases". Dis. Colon Rectum. 50 (4): 489–97. doi:10.1007/s10350-006-0821-x. PMID 17205203.
- ↑ Peoples JB, McCafferty JC, Scher KS (1990). "Operative therapy for sigmoid volvulus. Identification of risk factors affecting outcome". Dis. Colon Rectum. 33 (8): 643–6. PMID 2376219.
- ↑ Rashid F, Thangarajah T, Mulvey D, Larvin M, Iftikhar SY (2010). "A review article on gastric volvulus: a challenge to diagnosis and management". Int J Surg. 8 (1): 18–24. doi:10.1016/j.ijsu.2009.11.002. PMID 19900595.
- ↑ Ifversen AK, Kjaer DW (2014). "More patients should undergo surgery after sigmoid volvulus". World J. Gastroenterol. 20 (48): 18384–9. doi:10.3748/wjg.v20.i48.18384. PMC 4277976. PMID 25561806.
- ↑ Channer LT, Squires GT, Price PD (2000). "Laparoscopic repair of gastric volvulus". JSLS. 4 (3): 225–30. PMC 3113174. PMID 10987399.
- ↑ Tejler G, Jiborn H (1988). "Volvulus of the cecum. Report of 26 cases and review of the literature". Dis. Colon Rectum. 31 (6): 445–9. PMID 3288449.
- ↑ Hiltunen KM, Syrjä H, Matikainen M (1992). "Colonic volvulus. Diagnosis and results of treatment in 82 patients". Eur J Surg. 158 (11–12): 607–11. PMID 1363066.
- ↑ Baldarelli M, De Sanctis A, Sarnari J, Nisi M, Rimini M, Guerrieri M (2007). "Laparoscopic cecopexy for cecal volvulus after laparoscopy. Case report and a review of the literature". Minerva Chir. 62 (3): 201–4. PMID 17519847.