A study of large-bowel volvulus in urban Australia

Lau, K. C. N., Miller, B. J., Schache, D. J. and Cohen, J. R. (2006) A study of large-bowel volvulus in urban Australia. Canadian Journal of Surgery, 49 3: 203-207.

Author Lau, K. C. N.
Miller, B. J.
Schache, D. J.
Cohen, J. R.
Title A study of large-bowel volvulus in urban Australia
Journal name Canadian Journal of Surgery   Check publisher's open access policy
ISSN 0008-428X
Publication date 2006
Sub-type Article (original research)
Volume 49
Issue 3
Start page 203
End page 207
Total pages 5
Editor G. Warnock
J. Waddell
Place of publication Canada
Publisher Canadian Medical Association
Collection year 2006
Language eng
Subject C1
321029 Surgery
730109 Surgical methods and procedures
Abstract Background: Large-bowel volvulus is a rare cause of bowel obstruction in the industrialized world. We analyzed the presentation and outcome of 49 patients at the Princess Alexandra Hospital, Brisbane, Australia, who received a diagnosis of colonic volvulus from 1991 to 2001. Methods: A retrospective chart study was carried out. Results: Twenty-nine patients had sigmoid volvulus (59%), 19 patients had cecal volvulus (39%) and 1 patient had a transverse colon volvulus (2%). The diagnosis of sigmoid volvulus was made accurately on plain abdominal radiography or contrast enema in 90% of cases (n = 26), compared with only 42% of cases (n = 8) of cecal volvulus. Twenty-two patients with sigmoid volvulus were treated initially with endoscopic decompression. The success rate was 64% (n = 14). There was a high early recurrence rate of sigmoid volvulus for those treated by endoscopic decompression alone (43%) during a mean period of 32 days. Of the 14 patients with cecal volvulus who were treated with right hemicolectomy, 12 had primary anastomosis and 2 had end ileostomy with mucous fistula formation. There was no anastomotic leak following right hemicolectomy with primary anastomosis, even though 6 of these patients had an ischemic cecum. Conclusions: Endoscopic decompression of the sigmoid volvulus was safe and effective as an initial treatment but has a high early recurrence rate. Any patient who is fit enough to undergo operation should have a definitive procedure during the same admission to avoid recurrence. Cecal volvulus is associated with a higher incidence of gangrene and is treated effectively by right hemicolectomy with or without anastomosis. The need for swift operative intervention is emphasized.
Keyword Surgery
Acute Sigmoid Volvulus
Cecal Volvulus
Colon Volvulus
Management
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2007 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 10:18:28 EST