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Volvulus

Volvulus. 嘉義長庚醫院 大腸直腸外科 葉重宏. Colon twists on its own mesenteric axis venous congestion and infarction Gangrene Arterial supply comprised Ischemia. Distribution. Sigmoid colon : Most common Cecum T-Colon Splenic flexure. Sigmoid Volvulus. Prevalence

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Volvulus

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  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 Unsuccessful reduction Nonviability of colon Elective surgery after reduction • Procedure Sigmoid colectomy and anastomosis Hartmann’s procedure Detorsion and sigmoidpexy -- avoid

  10. Mortality 8 % -- elective surgery 28 % -- emergent surgery • Risk factor 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 -- Acute intestinal obstruction • Diagnosis Pain ABD : --- Coffee bean shape BAE : --- Bird’s beak deformity of cecum

  13. Treatment • Colonoscopy is not recommended • Surgery 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

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