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Volvulus, colonic obstruction, pseudo-obstruction
Pieter Dewint AZ Maria-Middelares, Ghent
UZ, Antwerp
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ShouldIstay(off)?
- Clinicalsignsofperitoni;s- HighCRP- Sepsis- Volvulus:smallbowel/caecal
=>SURGERY
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SmallversusLargebowelobstruc;on
Smallbowel Largebowel
Clinicalsigns-Onset:-Pain:-Transit:-Vomi;ng:
acute+++++/-++++
gradual++++-+/-
Bowelsounds Highpitched;nkling
Normal
X-Ray
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Volvulus
- Gastricvolvulus- Smallbowelvolvulus
- Colonicvolvulus
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LargebowelVolvulus
BrJRad2010
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LargebowelVolvulus
BrJRad2010
40-70 %
< 5 %
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SigmoidVolvulusEpidemiology
- 5–8%ofall“bowelobstruc;ons”- 40–90%recurrencerisk- 7%mortalityrisk
- Riskfactors:- “longloopofsigmoid”
- Elongatedmesentery
- Obs;pa;on
- NeurologicaldisordersEndIO2016
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SigmoidVolvulusTreatment
- Endoscopicdetorsion- Decompressiontube
- Sigmoidectomy-PEC
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SigmoidVolvulusPercutaneousEndoscopicColostomy
EndIO2016
Fixa;onofsigmoidloop- OneortwoPEC
- RemovalofPEC(ornot)
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SigmoidVolvulusPercutaneousEndoscopicColostomy
EndIO2016
- Complica;ons- Death 2/56
- PrematurePEC-“extrac;on” 1/56
- Migra;onofPEC,faecalspill 1/56
- Pain 1/56
- Leakage 1/56- Recurrence
- 2PEC 0%
- 1PEC 25%
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Malignantcolonicobstruc;on
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Survivalagersurgery
BrJSurg2006
Coloncancer
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Mortalityageremergencysurgery
Endoscopy2014
Coloncancer
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Surgicalprocedure
Coloncancer
DigSurg2015
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Postopera;veoutcome
Coloncancer
DigSurg2015
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Postopera;veoutcome
Coloncancer
DataJ.Vandervoort
OLV Cohort of stented patients Belgian Cancer Registry
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Endoscopy2014
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Endoscopy2014
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AcuteColonicPseudo-obstruc;onOgilvieSyndrome
DisColonRectum2016
- Dysregula;onofautonomicimpulsesinentericnervoussystem
- Old,hospitalized/ins;tu;onalizedpa;ents
- Progressiontoischemicperfora;on(3-15%)- Cecaldila;on>12cm,leucocytosis,CRP,fever,…
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AcuteColonicPseudo-obstruc;onAcutetreatment
- EndoscopyNOTrecommended
- Suppor;vetherapy- Bowelrest,fluid,electrolyte,drugs,infec;on,rectaltube,op;mal
posi;on,renalfunc;on…- Neos;gmine1---Endoscopy
- Serialimaging(X-Rayabdomen)
DisColonRectum2016,1NEJM,1999