Volvulus of the Colon: Surgical Experience

Abstract

Objective: Volvulus of the colon is a rare cause of intestinal obstruction that has had many types of management proposed over time. This study was designed to analyze results of various treatments through a review of patients with volvulus who were treated at our hospital. Methods: A total of 50 patients diagnosed with volvulus of the colon between 1982 and 2004 was collected, and each was assigned to one of four groups according to the mode of treatment. Results: Group 1 contained 10 patients who received colonoscopic decompression only; Group 2 contained 21 patients who underwent colonoscopic decompression followed by elective surgery; Group 3 contained 12 patients who received colonoscopic decompression followed by emergency surgery; and Group 4 contained 7 patients who underwent emergency surgery. Group 1 had no deaths, but the disease recurred in 7 of the 10 cases, requiring repeat colonoscopic decompression. Group 2, decompression followed by elective surgery, had one death and one patient who experienced significant morbidity (insufficiency of anastomosis requiring a diversion procedure). Group 3, decompression followed by emergency surgery, had three deaths and one patient with significant morbidity (with insufficiency of anastomosis requiring colostomy or ileostomy diversion). Finally, Group 4, initial emergency surgery, had three deaths and two patients with significant morbidity (colon obstruction and intra-abdominal abscess, each requiring an additional operative procedure for treatment). The overall mortality rate was 14% (7 of 50 patients). Conclusions: Colonoscopic decompression is the technique of choice for reducing volvulus of the colon if the patient has not yet developed peritonitis. However, decompression should be followed by definitive colectomy with anastomosis when the patient is medically fit to undergo surgery.