Volvulus of the sigmoid colon.

Sigmoid volvulus in children is quite rare and may occur in acute fulminating form requiring early diagnosis and surgery. In this case, bowel continuity after resection of the necrotic sigmoid was reestablished in a two-stage operation.     

Volvulus of the sigmoid colon

The authors report of 34 cases of sigmoid colon volvulus occurring in young subjects (15%) and in elderly subjects (60% over the age of 75 years). The diagnosis is frequently suggested by the clinical features and the history (30% of patients have a history of a previous identical episode) and is confirmed by a plain abdominal x-ray and/or an opaque enema. Endoscopy is performed in every case, except in the presence of peritoneal signs, in an attempt to perform detorsion and colonic intubation under direct vision in order to avoid emergency surgery; this procedure is effective in 87% of cases. Emergency surgery has a high mortality rate (43.5%). Elective or deferred emergency surgery after preparation is much safer (6.6% mortality). In patients with multiple diseases, non-surgical conservative management after detorsion too frequently results in repeated complications, leading to decompensation of the concurrent illnesses and a mortality rate of 34%. Endoscopic detorsion followed by surgical resection after a short 3 to 4 day preparation seems to be the best guarantee of therapeutic success.     

Volvulus of the sigmoid colon

Between 1983 and 1986, 18 patients with colonic volvulus (94.4% sigmoid, 5.6% caecal) were seen at Karadeniz Medical Faculty. There were 11 male and 7 female patients, with a mean age of 68 years. In 66.6% and 22.2% of patients respectively a palliative procedure or a Hartmann operation were performed. The recurrence rate in the palliative group was 30%. The mortality rate for all patients with volvulus was 16.8%. The palliative procedures were successful in patients in good general condition and without bowel necrosis, whereas the Hartmann operation gave successful results in patients with bowel necrosis.     

Laparoscopic segmental resection of the sigmoid colon for endometriosis.

We report a technique for laparoscopic segmental resection of the sigmoid colon. A 30.73-year-old nulligravida complained of pelvic pain, abdominal bloating, intestinal cramping, and painful bowel movements. Examination revealed significant nodularity of the posterior pelvis, so a preoperative bowel prep was given. At laparoscopy, a 5 cm diameter mid-sigmoid lesion was found, as well as a rectal nodule and pelvic endometriosis. The sigmoid lesion was separated from the mesocolon by bipolar electrocoagulation and scissors dissection. The segment was then removed by transection with a needle electrode and extraction through the anus. A stapled end to end anastomosis was performed. This technique can be applied to a variety of benign lesions of the bowel, and can result in decreased patient morbidity and hospital stay.     

Volvulus of the colon. Apropos of 37 cases]

A retrospective study of 37 case reports of patients with volvulus of the colon was carried out to define diagnostic and therapeutic strategies. The group comprised 22 men and 15 women, mean age 69 +/- 4 years (range 26-88 years), the volvulus being located in the sigmoid colon (n = 23), ascending colon (n = 13) or transverse colon (n = 1). The diagnosis, suggested by the straight abdominal film in almost all cases, was confirmed by a barium enema in 70% of cases. Treatment was surgical in 30 patients (81%) including 12 as emergency operations. Mortality was 5.4% (2 cases), and morbidity high (43% including fatal complications) the majority of adverse reactions being respiratory. Volvulus of the ascending colon was treated by hemicolectomy in 9 cases with no mortality or relapse. In patients with sigmoid volvulus, a "medical" reduction was performed in 7 patients, with success in 5 cases, one recurrence and no mortality, ideal sigmoidectomies in 14 cases resulting in one recurrence and no mortality. Right hemicolectomy appears to be the technique of choice even for urgent cases, there being no contraindications to a one-stage re-establishment of continuity. Inversely, an urgent intervention should at all costs be avoided in cases of sigmoid volvulus, a "medical" reduction (radiology, intubation, endoscopy) allowing preparation of the patient for a deferred ideal sigmoidectomy. Obviously, failure to reduce the volvulus or signs of colon necrosis require urgent surgery and raise the problem of whether or not to re-establish colon continuity.