Colonic Volvulus Incidence 7 per 100 000 in uk

Colonic Volvulus

• Incidence 1.7 per 100 000 in UK

• Wide geographical variation

• Elderly psychiatric institutionalised patients

• Mortality 7-30% per episode

Dilemma ? why

• No randomised trials

• No controlled trials

• No prospective audits

• Small retrospective studies

• Few up to date studies

Management options

• Non operative decompression

• Surgical resection

• Colopexy procedures

• Percutaneous endoscopic colostomy (PEC)

• No treatment

Non operative decompression

• Widely accepted

• Rigid sigmoidoscope or colonoscope

• 90% successful

• 5-8% mortality

• 22-90% recurrence

Surgery (1) Non viable bowel

• Resection (Hartmanns)

• Mortality 0-75%

Surgery (2) Viable bowel

• Early surgery

• Mortality (elective) 0-15%

• Choice of operation/survival

• ? Laparoscopic

Surgery (3) Sigmoid colectomy

• Good results in able bodied

• Sigmoid colectomy + anastomosis 37% recurrence

• Sigmoid colectomy + stoma 20% recurrence

• Associated mega colon 82% recurrence

• Mortality 0-15%

Surgery (4) Non resection

• Mesocoloplasty: mortality 40% recurrence 27%
• Colopexy: mortality 11% recurrence 21%
• Tube sigmoidostomy: mortality 0% recurrence 0%

Percutaneous endoscopic colostomy (PEC)

• Simpson et al BJS 2000

• 14 patients

• No deaths

• Tube removed 8 (3 recurred)

• Tube in situ 5 (0 recurred)

PEC

PEC (Sheffield)

• In Sheffield 11 date (Dr Mark McAlindon)

• 2 leaks

• 1 patient washout and PEC retained later converted to stoma

• 1 patient ITU emergency colostomy

Ceacal volvulus

• Colonoscopic de-rotation: high failure rate + delays operation

• Ceacostomy, Caecopexy or Right hemicolectomy

• Similar mortality (9 and 4.5%)

• 30% recurrence after ceacopexy

• 0% recurrence after tube ceacostomy

? No Treatment

• Northern Chapter of ACPGBI

• Scenario: elderly demented patient with sigmoid volvulus

• 65% no surgery

• 26% no colonoscopic decompression

Sigmoid volvulus (unfit patient)

Sigmoid volvulus (fit patient)