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Masui H, Kawada K, Inamoto S, Wada T, Sakai Y, Obama K. Laparoscopic redo surgery for sigmoid volvulus following laparoscopic sigmoidectomy. Surg Case Rep 2024; 10:163. [PMID: 38937390 PMCID: PMC11211295 DOI: 10.1186/s40792-024-01961-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Sigmoid volvulus (SV) is an acute abdominal condition characterized by torsion of the sigmoid colon around the mesentery, and often results in intestinal obstruction that may progress to bowel ischemia, necrosis, or perforation. Although SV commonly occurs due to predisposing factors like anatomic variations, age-related motility disorders, chronic constipation, and neurologic diseases, its incidence following sigmoid colon cancer surgery has rarely been reported. Herein, we report a rare case of recurrent SV following laparoscopic sigmoidectomy, which was successfully treated by laparoscopic redo surgery. CASE PRESENTATION The patient was a 77-year-old man who had previously undergone laparoscopic sigmoidectomy for sigmoid colon cancer. Sixteen months postoperatively, he developed an incisional hernia at the umbilical site, which was treated with a laparoscopic repair using an intraperitoneal onlay mesh. After the hernia surgery, the patient had no anastomotic leakage or stenosis on regular follow-ups. However, 65 months after the first surgery, he presented with abdominal pain and distension. A computed tomography revealed that the remnant sigmoid colon was distended in a twisting manner around the anastomosis, leading to the diagnosis of SV. Although endoscopic de-torsion was successful, the SV recurred 2 months later, requiring elective laparoscopic redo surgery. The procedure involved resection of the sigmoid colon including the prior anastomosis with a left pararectal incision and DST re-anastomosis using a 25-mm circular stapler. The operation lasted 165 min with minimal bleeding and no complications. The postoperative course was uneventful. Pathological analysis confirmed fibrosis without malignancy. The patient remains well without recurrence of SV and anastomotic stenosis more than 5 years after surgery. CONCLUSION SV following sigmoid colon cancer surgery has rarely been reported. This case illustrates the potential need for prophylaxis against postoperative SV, especially in patients with long sigmoid colon undergoing laparoscopic surgery for colorectal cancer. Further, laparoscopic redo surgery following initial laparoscopic surgery for colorectal cancer can be performed with minimal invasiveness, especially if patient selection is properly managed.
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Affiliation(s)
- Hideyuki Masui
- Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Departments of Surgery, Hirakata Kohsai Hospital, Osaka, Japan
| | - Kenji Kawada
- Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
- Department of Surgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Susumu Inamoto
- Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Toshiaki Wada
- Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Yoshiharu Sakai
- Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Kazutaka Obama
- Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
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Arnold SC, Rafaqat W, Abiad M, Lagazzi E, Hoekman AH, Panossian VS, Nzenwa IC, Paranjape CN, Velmahos GC, Kaafarani HMA, Hwabejire JO. Patience is key: Association of surgical timing with clinical outcomes in elderly patients with sigmoid volvulus. Am J Surg 2024; 232:81-86. [PMID: 38278705 DOI: 10.1016/j.amjsurg.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Current guidelines for sigmoid volvulus recommend endoscopy as a first line of treatment for decompression, followed by colectomy as early as possible. Timing of the latter varies greatly. This study compared early (≤2 days) versus delayed (>2 days) sigmoid colectomy. METHODS 2016-2019 NRD database was queried to identify patients aged ≥65 years admitted for sigmoid volvulus who underwent sequential endoscopic decompression and sigmoid colectomy. Outcomes included mortality, complications, hospital length of stay, readmissions, and hospital costs. RESULTS 842 patients were included, of which 409 (48.6 %) underwent delayed sigmoid colectomy. Delayed sigmoid colectomy was associated with reduced cardiac complications (1.1 % vs 0.0 %, p = 0.045), reduced ostomy rate (38.3 % vs 29.4 %, p = 0.013), an increased overall length of stay (12 days vs 8 days, p < 0.001) and increased overall costs (27,764 dollar vs. 24,472 dollar, p < 0.001). CONCLUSION In geriatric patient with sigmoid volvulus, delayed surgical resection after decompression is associated with reduced cardiac complications and reduced ostomy rate, while increasing overall hospital length of stay and costs.
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Affiliation(s)
- Suzanne C Arnold
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Wardah Rafaqat
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - May Abiad
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Emanuele Lagazzi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Anne H Hoekman
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Vahe S Panossian
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Ikemsinachi C Nzenwa
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Charudutt N Paranjape
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
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Chauhan S, Shinde RK, Jain Y. Navigating Abdominal Volvulus: A Comprehensive Review of Management Strategies. Cureus 2024; 16:e57978. [PMID: 38738029 PMCID: PMC11086050 DOI: 10.7759/cureus.57978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Abdominal volvulus represents a critical condition characterized by the abnormal twisting of the GI tract, potentially leading to obstruction and vascular compromise. Prompt recognition and appropriate management are essential to prevent complications and improve patient outcomes. This comprehensive review examines the anatomy, pathophysiology, clinical presentation, and diagnostic evaluation of, and management strategies for abdominal volvulus. Non-operative techniques, including detorsion and decompression, as well as surgical interventions, such as laparoscopic and open approaches, are discussed. Additionally, the importance of multidisciplinary collaboration and postoperative care is emphasized. Despite significant advancements, unresolved issues remain, necessitating further research to refine diagnostic and therapeutic approaches. Future directions, including exploring emerging technologies, offer promise for enhancing the management of this challenging condition. Overall, this review provides clinicians with valuable insights into the optimal management of abdominal volvulus, aiming to improve patient outcomes and enhance clinical practice.
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Affiliation(s)
- Simran Chauhan
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yashraj Jain
- General Surgery, Rajshree Nursing Home, Ashoknagar, IND
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Patil M, Gharde P. Unveiling a Coalescing Catastrophe: Pre-pyloric Perforation Co-existing With Sigmoid Volvulus in a Middle-Aged Patient. Cureus 2024; 16:e55042. [PMID: 38550410 PMCID: PMC10974888 DOI: 10.7759/cureus.55042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
Sigmoid volvulus is a common cause of colonic obstruction worldwide and constitutes the majority of all cases of colonic volvulus. It is more prevalent in those who are older than 70 years. The sigmoid colon, an S-shaped portion of the large intestine, is susceptible to this condition due to its redundancy and mobile nature. Treatment involves endoscopic detorsion with sigmoidectomy. Laparoscopic surgery has been found to be useful in terms of reduced morbidity, blood loss, analgesics, and hospital stay; contrarily, surgical management has been found to be associated with reduced recurrence. Early diagnosis is crucial to prevent complications and recurrence rates. Gastroduodenal perforation, whether spontaneous or traumatic, is predominantly associated with peptic ulcer disease. Specifically, the majority of perforated peptic ulcers are attributed to Helicobacter pylori infection. The presence of perforation as a comorbidity complicates surgical management, particularly when the patient has a history of H. pylori infections, as evidenced in our case. Addressing these infections is crucial for optimizing treatment outcomes and reducing potential complications. Laparoscopic surgery is popular due to its benefits and faster recovery periods, especially in the aged population. This is a case presentation of a 48-year-old male who presented at our tertiary care center with abdominal pain, multiple episodes of vomiting, obstipation, and abdominal distention. The patient was diagnosed with sigmoid volvulus with pre-pyloric perforation which was managed surgically by initial detorsion followed by sigmoidectomy with modified Graham's patch technique. He recovered well with no post-operative complications.
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Affiliation(s)
- Mihir Patil
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Gharde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Satheakeerthy S, Leow P, Hall B, Yen DA, Fischer J. Outcomes for sigmoid volvulus managed with and without early definitive surgery: 20-year experience in a tertiary referral centre. ANZ J Surg 2024; 94:169-174. [PMID: 37626456 DOI: 10.1111/ans.18671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Sigmoid volvulus is rare in Western countries. Patients at risk of sigmoid volvulus are often older with significant co-morbidity. Without sigmoid colectomy there is a high recurrence rate, but indications for surgery are controversial. METHODS A retrospective observational study was conducted by reviewing clinical records of patients admitted to Waikato Hospital 1 January 2000 to 1 January 2020 with a diagnosis of sigmoid volvulus. Patient characteristics, clinical features, investigations, management, and outcomes were recorded. RESULTS One hundred and thirty-two patients (87 male) were included with 203 volvulus episodes. Median age 76 years, median Charlson co-morbidity index (CCI) 4. Median follow-up 11 years. 44/132 (33.3%) had surgery during the index admission, two had elective surgery and the remainder had planned non-operative management. 73/132 (55.3%) had surgery at any stage. 42/86 (48.8%) patients managed non-operatively recurred; 66.7% of recurrences were within 6 months. Forty-three (32.6%) died within 12 months of index admission; 28 (21.2%) died during an admission for volvulus. On univariate analysis higher age and abnormal vital signs were associated with inpatient and 12-month mortality; higher CCI was associated with 12-month mortality. On multi-variate analysis increasing age in years was associated with increased risk of death (HR 1.089 [1.052-1.128, P < 0.001]). Normal vital signs at presentation were associated with decreased risk of death (HR 0.147 [0.065-0.334, P < 0.001]). CONCLUSION Sigmoid colectomy should be considered at index presentation with sigmoid volvulus. Half of patients managed non-operatively recurred, with two-thirds recurring within 6 months. The mortality rate remains high for subsequent volvulus episodes.
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Affiliation(s)
| | - Priscilla Leow
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Benjamin Hall
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Damien Ah Yen
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Jesse Fischer
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, University of Auckland, New Zealand
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Schabl L, Holubar SD, Erozkan K, Alipouriani A, Sancheti H, Steele SR, Kessler H. Epidemiology and age-related trends in surgical outcomes for sigmoid volvulus: a 17-year analysis. Langenbecks Arch Surg 2024; 409:37. [PMID: 38217626 DOI: 10.1007/s00423-024-03228-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Sigmoid volvulus, a gastrointestinal disorder characterized by twisted bowel, often requires medical intervention, either through endoscopic or surgical means, to avoid potentially severe outcomes. This study examined the challenges elderly patients face in undergoing surgical treatment, encompassing both mortality and morbidity. Furthermore, it aimed to determine how medical practices and outcomes have changed over a period of 17 years. METHODS We utilized data from the National Surgical Quality Improvement Project, which covers the period from 2005 to 2021, to identify patients who underwent left hemicolectomy for colonic volvulus. The patients were categorized into three age groups: < 60 years, 60-75 years, and > 75 years. We performed a meticulous logistic regression analysis, carefully adjusted for risk factors, to compare mortality, morbidity, and types of surgical treatment administered among the different age groups. RESULTS Our study included 6775 patients. The breakdown of the patient population was as follows: 2067 patients were < 60 years of age, 2239 were between 60 and 75 years of age, and 2469 were > 75 years of age. The elderly cohort, those aged above 75 years, were predominantly male, had lower BMIs, underwent fewer laparoscopic surgeries, required more diverting stomas and end-ostomies, and had longer hospital stays. Notably, the elderly population faced a mortality risk that was 5.67 times (95% CI 3.64, 9.20) greater than that of their youngest counterparts, with this risk increasing by 10% (95% CI 1.06, 1.14) for each additional year of age. Furthermore, the odds of mortality associated with emergency surgery were 1.63 times (95% CI 1.21, 2.22) higher than those associated with elective surgery. The postoperative morbidity odds were also elevated for emergency surgeries, 1.30 times (95% CI 1.08, 1.58) greater than that for elective cases. Over the 17-year period, we observed a decline in mortality rates, an increase in the utilization of laparoscopic procedures, and overall stability of morbidity rates. CONCLUSION Our findings highlight the increased vulnerability of patients over 75 years of age, who are not only at an elevated risk of mortality compared to their younger counterparts, but also a continuously increasing risk with age. By focusing on elective surgeries for younger patients and minimizing emergency surgeries for the elderly, it may be possible to reduce the mortality risk associated with surgical interventions in this population.
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Affiliation(s)
- Lukas Schabl
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
- Department for General, Visceral, and Thoracic Surgery, University Hospital Salzburg, Salzburg, Austria.
| | - Stefan D Holubar
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kamil Erozkan
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Alipouriani
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Himani Sancheti
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Scott R Steele
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hermann Kessler
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
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Awedew AF, Asefa Z, Enkoye BD. Comparing Resection and Primary Anastomosis versus Hartmann's Stoma on the Mortality and Morbidity of Gangrenous Sigmoid Volvulus: Systematic Review and Meta-Analysis. Ethiop J Health Sci 2023; 33:1087-1096. [PMID: 38784481 PMCID: PMC11111268 DOI: 10.4314/ejhs.v33i6.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/31/2023] [Indexed: 05/25/2024] Open
Abstract
Background Gangrenous sigmoid volvulus has a significant impact on morbidity and mortality. This study was conducted to compare sigmoid resection and primary anastomosis (RPA) with sigmoid resection and end colostomy (Hartmann's procedure) for gangrenous sigmoid volvulus. Methods A systematic review and meta-analysis study design was employed to summarize retrospective cohort, prospective cohort, and randomised control trial studies published from inception to march 31, 2023. Searching was performed on Medline, CINAHAL, Web of Science, Google Scholar, the Cochrane Library, and ClinicalTrials.gov to locate eligible articles. Data searching, selection and screening, quality assessment of the included articles, and data extraction were done by two separate reviewers. RevMan 5.4 software with a fixed-effect Mantel-Haenszel model and Stata version 14 were used to analyze the data. The protocol registered on PROSPERO registration website (CRD42023413367). Results Ten cohort studies and one randomised control trial with 724 patients were found; all of them were rated as being of moderate quality. The overall mortality after RPA was 15% (95%CI: 11-19%), and after Hartmann's procedure it was 19% (95%CI: 15-23%). Resection and primary anastomosis (RPA) for gangrenous sigmoid volvulus had slightly lower mortality rate than stoma (OR=0.98(95%CI: 0.68-1.42), p=0.07, I2=43%), which had no statistically significant difference. Resection and primary anastomosis (RPA) had a slightly higher morbidity rate than Hartmann's procedure (OR=1.01(95%CI: 0.66-1.55), p=0.30, I2=18%), which had no statistically significant difference. Conclusion Sigmoid resection and primary anastomosis (RPA) and Hartmann's procedure had no significant differences in mortality and morbidity for the treatment of gangrenous sigmoid volvulus. Choice of the intervention for gangrenous sigmoid volvulus should be individualized with consideration of different detrimental factors.
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Affiliation(s)
| | - Zelalem Asefa
- Department of surgery, Addis Ababa University, Ethiopia
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Deresse T, Tesfahun E, Gebreegziabher ZA, Bogale M, Alemayehu D, Dessalegn M, Kifleyohans T, Eskandar G. Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study. Open Access Emerg Med 2023; 15:383-392. [PMID: 37876607 PMCID: PMC10591608 DOI: 10.2147/oaem.s430193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
Background Acute sigmoid volvulus is a surgical emergency with closed-loop obstruction of the colon that often requires emergency laparotomy, which is associated with a multitude of post-operative complications. Although sigmoid volvulus is the main cause of intestinal obstruction in Ethiopia, local studies of its management outcomes are limited. Objective To assess the magnitude and predictors of adverse perioperative outcomes of emergency laparotomy for acute sigmoid volvulus in the Debre Markos Comprehensive Specialized Hospital (DMCSH), Amhara region, Ethiopia in 2023. Methods This was a retrospective follow-up study. Descriptive statistics were used to measure perioperative outcomes and other study variables. Bivariable and multivariable logistic regression models were used to identify the predictors of adverse surgical outcomes. Associations were considered significant at p < 0.05 (95% confidence interval). Results In total, 170 study participants were enrolled, with a response rate of 91.4%. Forty-nine patients (28.8%) developed perioperative adverse outcomes. Pneumonia (29 patients, 28.1%), surgical site infection (19 patients, 18.4%), and wound dehiscence (10 patients, 9.7%) were the most common complications. Pre-operative shock [AOR: 3.87 (95% CI: (1.22, 12.28))], pus or fecal matter contamination of the peritoneum [AOR: 4.43 (95% CI: (1.35, 14.47)], and a higher American Society of Anesthesiologists (ASA) score [AOR: 2.37 (95% CI: (1.05, 5.34))] were identified as predictors of perioperative adverse events. Conclusion The perioperative adverse outcomes in this study were higher than those reported in Ethiopian national and global reports following emergency laparotomies. Hypotension at presentation, pus and/or fecal matter contamination of the peritoneum, and higher ASA scores are strong predictors of increased perioperative adverse outcomes. Therefore, healthcare providers and institutions involved in the delivery of emergency surgical care should emphasize the importance of early surgical intervention, adequate resuscitation, and patient monitoring to improve perioperative outcomes.
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Affiliation(s)
- Tilahun Deresse
- Department of Surgery, Debre Berhan University, Debre Berhan, Ethiopia
| | - Esubalew Tesfahun
- Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
| | | | - Mandante Bogale
- Department of Surgery, Debre Markos University, Debre Markos, Ethiopia
| | - Dawit Alemayehu
- Department of Surgery, Debre Markos University, Debre Markos, Ethiopia
| | - Megbar Dessalegn
- Department of Surgery, Debre Markos University, Debre Markos, Ethiopia
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Ekhaiyeme P, Olagunju N, Ajagbe O, Bello O, Yatu P, Afuwape O, Irabor D. A RARE METACHRONOUS COLONIC VOLVULUS. Ann Ib Postgrad Med 2023; 21:81-83. [PMID: 38298341 PMCID: PMC10811709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/30/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Colonic volvulus is a common cause of large bowel obstruction with the sigmoid colon most commonly affected. Volvulus of the transverse colon is an uncommon occurrence. Rarer still is a transverse colon volvulus developing after surgery for a sigmoid colon volvulus. Early diagnosis is critical as delay in detection and intervention is associated with the risk of complications - perforation, peritonitis, and death. Case presentation We report the case of an 86-year-old man who presented with features of large bowel obstruction 14 months following a sigmoid colectomy for a sigmoid colon volvulus. Conclusion A metachronous transverse colonic volvulus is uncommon. Preoperative diagnosis is challenging as there are no defining radiographic features compared to the volvulus of the sigmoid colon with the classical omega sign. Most cases are diagnosed intra-operatively. Bowel resection and anastomosis in a single stage is a safe option.
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Affiliation(s)
- P.A. Ekhaiyeme
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
| | - N.A. Olagunju
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
| | - O.A. Ajagbe
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
| | - O.J. Bello
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
| | - P.H. Yatu
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
| | - O. Afuwape
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - D.O. Irabor
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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10
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Schudrowitz N, Shahan CP, Moss T, Scarborough JE. Bowel Preparation Before Nonelective Sigmoidectomy for Sigmoid Volvulus: Highly Beneficial but Vastly Underused. J Am Coll Surg 2023; 236:649-655. [PMID: 36695556 DOI: 10.1097/xcs.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Although strong evidence exists for combined mechanical and oral antibiotic bowel preparation before elective colorectal resection, the utility of preoperative bowel preparation for patients undergoing sigmoid resection after endoscopic decompression of sigmoid volvulus has not been previously examined. The goal of this study was to evaluate the association between bowel preparation and postoperative outcomes for patients undergoing semielective, same-admission sigmoid resection for acute volvulus. STUDY DESIGN Patients from the 2012 to 2019 Colectomy-Targeted American College of Surgeons NSQIP dataset who underwent sigmoid resection with primary anastomosis after admission for sigmoid volvulus were included. Multivariable logistic regression was used to compare the risk-adjusted 30-day postoperative outcomes of patients who received combined preoperative bowel preparation with those of patients who received either partial (mechanical or oral antibiotic alone) or incomplete bowel preparation. Effort was made to exclude patients whose urgency of clinical condition at hospital admission precluded an attempt at preoperative decompression and subsequent bowel preparation. RESULTS Included were 2,429 patients, 322 (13.3%) of whom underwent complete bowel preparation and 2,107 (86.7%) of whom underwent partial or incomplete bowel preparation. Complete bowel preparation was protective against several postoperative complications (including anastomotic leak), mortality, and prolonged postoperative hospitalization. CONCLUSIONS This study demonstrates a significant benefit for complete bowel preparation before semielective, same-admission sigmoid resection in patients with acute sigmoid volvulus. However, only a small percentage of patients in this national sample underwent complete preoperative bowel preparation. Broader adoption of bowel preparation may reduce overall rates of complication in patients who require sigmoid colectomy due to volvulus.
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Affiliation(s)
- Natalie Schudrowitz
- From the Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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11
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Jeong Y, Kim Y, Kim W, Park S, Shin SJ, Park EJ. Colonic pseudo-obstruction in a patient with dyssynergic defecation: A case report. Int J Surg Case Rep 2022; 98:107524. [PMID: 35987028 PMCID: PMC9404327 DOI: 10.1016/j.ijscr.2022.107524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance: Colonic pseudo-obstruction (CPO) is characterized by massive colonic dilatation of the large intestine without mechanical obstruction. In this study, we report our surgical experience in treating refractory CPO with increased anal sphincter tone, suggested as type IV dyssynergia. Case presentation A 48-year-old man with intellectual disability, depression, heart failure, and end-stage renal disease presented with acute exacerbation of CPO. He had a history of chronic constipation and abdominal distension. Colonic dilatation and defecation difficulty persisted despite medication and repeated colonoscopic decompression. Anal manometry results indicated type IV dyssynergia with increased rectal pressure. Hartmann′s operation was performed to resect the redundant megacolon and to avoid increased anal sphincter pressure during defecation. Hypoganglionosis was observed in the resected colon, which could worsen the chronic process of CPO. Clinical discussion Meticulous evaluation and careful management are required to treat CPO patients because the pathophysiology of CPO has not yet been clearly identified. Proper surgical treatment is needed for patients with refractory CPO. Conclusion CPO requires meticulous evaluation and careful management owing to the risk of bowel perforation. Precise evaluation to identify other factors affecting defecation problems accompanied by CPO is required to make appropriate treatment decisions. Colonic pseudo-obstruction is defined as massive colonic dilatation of the large intestine without mechanical obstruction. Dyssynergic defecation results from an abnormality for defecations and discordance for contraction of anal sphincter. Surgical resection is considered in patients with refractory colonic pseudo-obstruction and colonic aganglinosis.
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Affiliation(s)
- Yejun Jeong
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yongjae Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wonhyun Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seoyeon Park
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su-Jin Shin
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Jung Park
- Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Atamanalp SS. Comments on "Surgical Management of Sigmoid Volvulus: A Multicenter Observational Study". Ann Coloproctol 2021; 37:73-74. [PMID: 33979906 PMCID: PMC8134924 DOI: 10.3393/ac.2021.01.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
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