Inês Sousa (Leiria / PT), Nuno Rama (Leiria / PT), Miguel Coelho dos Santos (Leiria / PT), Rita Banza (Leiria / PT), Patrícia Bargas (Leiria / PT), Sofia Dias da Silva (Leiria / PT), Marisa Ferreira (Leiria / PT), Miguel Neves (Leiria / PT), Alexandra Rocha (Leiria / PT)
Abstract text (incl. references and figure legends)
Introduction: Acute colonic volvulus is a torsion of colon around its mesenteric axis, which leads to acute large intestine obstruction and can result in life-threatening complications. A prompt diagnosis of this disease is essential for appropriate treatment to correct abnormal pathophysiological changes and restore intestinal transit caused by the volvulus.
Material & Methods: A retrospective review of 23 patients with acute colonic volvulus treated in a secondary Portuguese hospital, from 2016 to 2020. Data recorded included baseline demographics, indication for surgery, operative details, length of hospital stay and complications.
Results: This study included 22 patients, 73% males, with a median age of 69 years. 47% of the patients had a previous episode of colonic volvulus that resolved with colonoscopic detorsion. The diagnosis was made by imaging exams in 67% of the patients. 73% were submitted to colonoscopy, which was effective in 91% of the patients. Nevertheless, there was a relapse in 80% of patients. All these patients were admitted to emergency surgery (laparotomic resection), 73% for sigmoid volvulus and 87% for cecum volvulus. 40% had a primary anastomosis and 60% had a Hartmann procedure. The mean post-operative period was 12 days. 67% had complications – of these, 20% needed a reoperation (for anastomotic dehiscence and hemoperitoneum). 27% of patients died during hospital admission.
Conclusions: Acute colonic volvulus demands an early diagnosis and treatment for better outcomes. Colonoscopy is the primary emergency treatment of choice in uncomplicated acute colonic volvulus. Emergency surgery is considered for patients who have failed nonsurgical treatment or who have peritonitis.
References: Lee K., et al.: Surgical Management of Sigmoid Volvulus: A Multicenter Observational Study. Ann Coloproctol 2020, 26(6). Thornton S., et al.: Sigmoid and Cecal Volvulus Treatment & Management. Medscape (Updated Jul, 2022).
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