Colonic volvulus. Diagnosis and results of treatment in 82 patients

Abstract

Objective: To test the accuracy of initial diagnosis of colonic volvulus and the results of different treatment regimens.

Design: Retrospective population based study.

Setting: Tampere University Hospital (major referral center).

Subjects: All patients who presented with colonic volvulus from 1973-1990, 58 patients had sigmoid, 23 caecal and one had transverse colonic volvulus.

Main outcome measures: Findings of endoscopic or operative treatment compared with the clinical diagnosis and plain abdominal radiographs. Association between treatment and risk factors.

Results: Diagnosis was difficult, despite some differences in clinical presentation. Gangrenous bowel was diagnosed only at operation, although caecal volvulus with gangrenous bowel was associated with a high white cell count. In 23 patients with caecal volvulus both right hemicolectomy (n = 11) and tube caecostomy (n = 7) were successful with one death after each procedure and no recurrences. In sigmoid volvulus, resection (n = 19) and detorsion with or without sigmoidopexy (n = 21) resulted in similar numbers of complications and deaths (6 and 4, and 5 and 3, respectively), though recurrences were more common after detorsion (1 (5%) compared with 5 (24%)). Endoscopic decompression was tried in 30 and was successful in 26 cases; it was the only treatment in 17/58 patients, with two deaths (12%) and five recurrences (29%). The overall mortality was 15%, but this was associated more with neuropsychiatric diseases, old age, and residence in mental or nursing homes than with gangrene of the bowel.

Conclusions: Poor diagnostic accuracy is a problem. Caecal volvulus can be safely treated by resection or tube caecostomy. Sigmoid volvulus is best treated by endoscopic detorsion followed by operation in otherwise fit patients. Mortality is associated with neuropsychiatric diseases and old age.