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Colonic Volvulus

Volvulus of the Colon


Presentation

  • CASE PRESENTATION We present a 26-year-old male patient who presented at our accident and emergency department with complete bowel obstruction of 3 days’ duration.[academic.oup.com]
  • A plan of management with the major aim to convert emergency situations into elective or urgent ones is presented with the expectation that the mortality rate can be improved. Related Topics Related Articles Loading Related Articles[insights.ovid.com]
  • Funding and Disclosures * Presented at the annual meeting of the New England Surgical Society, Worcester, October 5, 1946.[nejm.org]
  • The acute form presents in sixty percent of children [ 3 ].[wjes.biomedcentral.com]
Sepsis
  • […] empty segments of the ileum and distal jejunum twist clockwise around the narrow base of the sigmoid colon. 4 Double volvulus is a condition that rapidly progresses to gangrene of both twisted segments and the most common complications are peritonitis, sepsis[revistagastroenterologiamexico.org]
  • If the volvulus progresses to intestinal strangulation, patients will exhibit increasing abdominal pain to peritonitis and sepsis.[ncbi.nlm.nih.gov]
Collapse
  • […] study may help in the diagnosis by showing the typical ‘bird’s beak’ appearance. [4, 6 ] Computerised tomogram scan (CT scan) has the highest sensitivity, and will help delineate the closed loop obstruction, marked dilatation of the proximal colon and collapse[tropicalgastro.com]
  • […] and a diet simultaneously high in volume and abundant liquid intake. 4 In relation to its pathogeny, it is suggested that when the abovementioned diet is ingested, it progresses through segments of the jejunum, making them heavier, and causing their collapse[revistagastroenterologiamexico.org]
  • The descending colon appears collapsed. The distribution of the large bowel dilatation raises the possibility of proximal descending colon obstruction. Figure 2 Abdominal CT provides a differential of a colo-colic intussusception or volvulus.[wjes.biomedcentral.com]
  • Intraoperative findings were a sigmoid volvulus and to our surprise a concurrent transverse colon volvulus with a non-distended cecum and collapsed small bowels.[academic.oup.com]
Anemia
  • If gangrene is encountered, which can occur in 23 to 100% of cases, resection is mandatory. 49 If the patient's ability to heal is compromised by malnutrition, anemia, chronic steroids, or other conditions, resection with ileostomy, with or without mucous[ncbi.nlm.nih.gov]
Soft Tissue Mass
  • Like plain films, CT may reveal the coffee bean and bird beak signs, as well as the whirl sign, which is the radiographic interpretation of a soft tissue mass containing swirling strands of soft tissue and fat attenuation.[ncbi.nlm.nih.gov]
Cerebral Palsy
  • Abnormal posture in children with cerebral palsy may also be a contributory factor for distention of the colon [ 6 ]. Our patient had a related risk factor of scoliokyphosis with cerebral palsy.[synapse.koreamed.org]
  • This was a case of cerebral palsy who initially presented with transverse colon volvulus and resection and colocolic anastomosis was performed following which he developed a sigmoid volvulus.[academic.oup.com]
  • palsy N/A Resection with primary anastomosis 13 Jornet 2003 12 M distension nil 180 Detorsion 14 Liolios 2003 10 F vomiting constipation distension trisomy 13, mental retardation, chronic constipation 360 clockwise Detorsion.[wjes.biomedcentral.com]
Abdominal Pain
  • She returned 3 weeks later due to sudden abdominal pain, distension, fecaloid vomiting, and dehydration of 2-day progression.[revistagastroenterologiamexico.org]
  • Case Presentation A fifteen year old boy presented with a three day history of left sided abdominal pain, constipation and vomiting to the pediatricians. Over the preceding year he had several episodes of intermittent abdominal pain.[wjes.biomedcentral.com]
  • pain, bilious vomiting and obstipation for duration of one day.[tropicalgastro.com]
  • In the emergency department, a person presenting with abdominal pain may initially require IV fluids due to decreased intake secondary to abdominal pain and possible emesis or vomiting. [12] Treatment for abdominal pain includes analgesia, such as non-opioid[en.wikipedia.org]
Upper Abdominal Pain
Denial
  • Diagnosis is often delayed by the denial of usual radiographic techniques in fear of damage to the fetus.[ncbi.nlm.nih.gov]
Enlarged Uterus
  • A gas-filled appendix may also be seen. 36 In pregnant patients, the enlarged uterus may displace a mobile cecum out of the pelvis, and obstruction may occur from the kinking of the colon at a fixed point.[ncbi.nlm.nih.gov]
Neglect
  • […] mesentery, congenital errors of midgut rotation); mechanical (previous surgery, adhesions, distal obstruction) and physiological (chronic constipation, pregnancy, colitis), it can rotate, leading to a closed loop obstruction, gangrene or even perforation in neglected[tropicalgastro.com]

Workup

  • What laboratory workup is indicative of volvulus? Well, not a whole lot. Your chemistries may be normal. You may have an increased white blood cell count.[lecturio.com]
  • […] complete blood count, urine pregnancy test followed with quantitative blood beta-hCG Imaging: transvaginal ultrasound If patient is unstable: IV fluid resuscitation, urgent obstetrics and gynecology consultation If patient is stable: continue diagnostic workup[en.wikipedia.org]
  • This occurs despite the feasibility of prudent use of abdominal x-rays and CT scans. 45 Patients will often go to surgery without a full workup and diagnosis is made in the operating room. 46 Nonsurgical treatment for cecal volvulus via endoscopy is generally[ncbi.nlm.nih.gov]

Treatment

  • In the absence of a randomized study, the type of surgical treatment remains controversial, although colonic resection with restoration of continuity is the standard treatment [ 4, 8, 44 ].[em-consulte.com]
  • Diagnosis and Treatment of Sigmoid Volvulus Prompt diagnosis and appropriate treatment of sigmoid volvulus generally lead to a successful outcome.[colorectal.surgery.ucsf.edu]
  • Moreover, the epidemiology and diagnosis of each type of colonic volvulus, along with the various treatment options will be reviewed.[ncbi.nlm.nih.gov]

Prognosis

  • The multidisciplinary strategy will therefore depend on the term of pregnancy and the fetal prognosis.[em-consulte.com]
  • Objective: To describe the clinical presentation, type of surgical procedures performed, and to determine the prognosis of sigmoid volvulus.[scopemed.org]
  • […] mesenteric vessels bird's beak sign : if rectal contrast has been administered 6 X-marks-the-spot sign : crossing loops of bowel at the site of the transition split wall sign : mesenteric fat seen indenting or invaginating the wall of the bowel Treatment and prognosis[radiopaedia.org]
  • However, in instances where a volvulus has lead to tissue death in the bowel, the prognosis may be poor.[medicalnewstoday.com]
  • Furthermore, it has a very variable rate of success and is very case dependent. [29] Prognosis Complications that can arise from constipation include hemorrhoids, anal fissures, rectal prolapse, and fecal impaction. [15] [22] [46] [47] Straining to pass[en.wikipedia.org]

Etiology

  • Etiology The etiology of colon volvulus is probably multifactorial. Some factors are common to all locations of volvulus, such as chronic constipation, high fiber diet, frequent use of laxatives, history of laparotomy and anatomic predisposition.[em-consulte.com]
  • It is a potentially fatal condition whose etiology has been recognized for centuries. It can occur at different points in the colon, in patients of all ages, and risk factors include a high-fiber diet.[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiology The incidence of colon volvulus varies in different regions of the world.[em-consulte.com]
  • The epidemiology, aetiology, diagnosis and management of transverse colon volvulus are discussed. It is important to highlight this case and those in the literature, as many surgeons may never have seen a single case of transverse colon volvulus.[wjes.biomedcentral.com]
  • Epidemiology Constipation is the most common chronic gastrointestinal disorder in adults.[en.wikipedia.org]
  • Moreover, the epidemiology and diagnosis of each type of colonic volvulus, along with the various treatment options will be reviewed.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. . Accessed Sept. 10, 2015. Glancy DG. Intestinal obstruction. Surgery. 2014;34:204.[mayoclinic.org]
  • Pathophysiology In sigmoid volvulus, mesosigmoid twisting of up to 180 is considered physiological. In approximately 2% of cases, the volvulus reduces spontaneously [ 2 ].[em-consulte.com]
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features (9 ed.). Elsevier Health Sciences. p. 384. ISBN 1437727670.[en.wikipedia.org]

Prevention

  • Resection prevents volvulus from recurring; untwisting the volvulus with the sigmoidoscope may not prevent recurrence. Cecal Volvulus Cecal volvulus is twisting of the cecum and ascending colon.[colorectal.surgery.ucsf.edu]
  • Both of these procedures have high success rates and generally prevent recurrence.[wexnermedical.osu.edu]
  • The child may also be given intravenous (IV) fluids to help prevent dehydration and antibiotics to prevent infection.[kidshealth.org]
  • See also [ edit ] Colonoscopy Notes [ edit ] a b Hoff, G.; Grotmol, T.; Skovlund, E.; Bretthauer, M.; Norwegian Colorectal Cancer Prevention Study Group (2009).[en.wikipedia.org]
  • Early diagnosis and treatment of volvulus can help prevent serious complications. However, in instances where a volvulus has lead to tissue death in the bowel, the prognosis may be poor.[medicalnewstoday.com]

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