From the Guidelines
Treatment for volvulus typically involves urgent surgical intervention, with sigmoid resection and primary anastomosis being a common approach for sigmoid volvulus, as recommended by the WSES consensus guidelines 1. The goal of treatment is to prevent recurrence and address any complications such as bowel necrosis or perforation.
- In cases where endoscopic detorsion is successful, sigmoid colectomy should be offered to prevent recurrent volvulus, with the procedure being performed as early as possible, even during the index admission 1.
- The decision to perform an isolated sigmoid colectomy versus a high anterior resection should be individualized, taking into account the vascular supply of the remnant colon 1.
- The choice of surgical approach, whether laparotomy or laparoscopy, should be left to the comfort of the surgeon, with laparoscopic surgery being a suitable alternative in select cases 1.
- Post-operative care includes monitoring for complications like infection or anastomotic leak, and patients with recurrent volvulus or high surgical risk may be considered for less invasive procedures like endoscopic fixation (colopexy) 1. Key considerations in the treatment of volvulus include:
- Urgent medical attention to prevent complications such as bowel necrosis or perforation
- Individualized approach to surgical intervention, taking into account the patient's overall condition and the specific characteristics of the volvulus
- Monitoring for post-operative complications and consideration of less invasive procedures for patients with recurrent volvulus or high surgical risk. The most recent and highest quality study recommends sigmoid colectomy as the most effective intervention for preventing recurrent volvulus, with low morbidity and mortality rates 1.
From the Research
Treatment for Volvulus
The treatment for volvulus typically involves surgical intervention. The goal of surgery is to reduce the volvulus, repair any underlying defects, and prevent recurrence.
- Surgical approaches for volvulus include:
- Laparoscopic repair: This is a minimally invasive approach that has been shown to be safe and effective for the treatment of acute gastric volvulus 2, 3.
- Open surgical repair: This approach is also effective and may be preferred in certain cases, such as when there is a high risk of complications or when the patient has had previous abdominal surgery 4.
- The choice of surgical approach depends on various factors, including the location and type of volvulus, the patient's overall health, and the surgeon's preference.
- In some cases, a combination of surgical techniques may be used, such as laparoscopic reduction of the volvulus followed by open surgical repair of any underlying defects.
- Postoperative care is important to prevent complications and promote recovery. This may include measures such as:
- Monitoring for signs of complications, such as bleeding or infection
- Managing pain and discomfort
- Providing nutritional support to promote healing
- Encouraging early mobilization to prevent complications such as deep vein thrombosis
Types of Volvulus
There are different types of volvulus, including:
- Gastric volvulus: This is a rare condition in which the stomach twists abnormally 2, 3.
- Sigmoid volvulus: This is a type of volvulus that occurs in the sigmoid colon 4.
- Intestinal volvulus: This is a rare disease process that requires high suspicion and timely diagnosis 5.
- Cecal volvulus: This is a type of volvulus that occurs in the cecum, which is the first part of the large intestine 6.
Complications of Volvulus
Complications of volvulus can be serious and may include:
- Intestinal necrosis
- Perforation of the intestine
- Peritonitis
- Sepsis
- Death It is essential to recognize the signs and symptoms of volvulus early and to seek medical attention promptly if suspected 5.