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  • Title: Preoperative colonoscopic derotation is beneficial in acute colonic volvulus.
    Author: Renzulli P, Maurer CA, Netzer P, Büchler MW.
    Journal: Dig Surg; 2002; 19(3):223-9. PubMed ID: 12119526.
    Abstract:
    AIMS: Analysis of preoperative and operative management of acute colonic volvulus and development of treatment guidelines in a region of low incidence. METHODS: A study of 42 consecutive patients operated for acute colonic volvulus between 1970 and 2000. RESULTS: There were 20 patients with sigmoid volvulus, 21 with cecal volvulus and 1 with volvulus of the transverse colon. All patients presented as emergencies. The correct preoperative diagnosis was possible for sigmoid volvulus in 95% (19/20) of cases and for cecal volvulus in 67% (14/21). Preoperative colonoscopic volvulus derotation was attempted in 19 patients and successfully completed in 9 patients (47%). The success rates for preoperative colonoscopic derotation were 58 (7/12) and 33% (2/6) for sigmoid and cecal volvulus, respectively. Thirty-four patients (81%) underwent colon resections, 26 times as a single-stage procedure, and 8 patients (19%) underwent non-resectional operative techniques. Overall surgical morbidity was 24%, the reoperation rate 9.5% and mortality 12% (5/42). The subgroup of 9 patients with successful non-operative volvulus derotation, however, underwent semi-elective single-stage colonic resection without surgical morbidity or mortality. There were no recurrences during a median follow-up period of 9.5 years. CONCLUSION: In the absence of clinical, laboratory or radiological signs of bowel necrosis or perforation, colonoscopic volvulus derotation is recommended in all cases of acute colonic volvulus, followed by semi-elective single-stage colonic resection.
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