Volvulus, colonic obstruction, pseudo-obstruction

Pieter Dewint AZ Maria-Middelares, Ghent

UZ, Antwerp

ShouldIstay(off)?

-  Clinicalsignsofperitoni;s-  HighCRP-  Sepsis-  Volvulus:smallbowel/caecal

=>SURGERY

SmallversusLargebowelobstruc;on

Smallbowel Largebowel

Clinicalsigns-Onset:-Pain:-Transit:-Vomi;ng:

acute+++++/-++++

gradual++++-+/-

Bowelsounds Highpitched;nkling

Normal

X-Ray

Volvulus

-  Gastricvolvulus-  Smallbowelvolvulus

-  Colonicvolvulus

LargebowelVolvulus

BrJRad2010

LargebowelVolvulus

BrJRad2010

40-70 %

< 5 %

SigmoidVolvulusEpidemiology

-  5–8%ofall“bowelobstruc;ons”-  40–90%recurrencerisk-  7%mortalityrisk

-  Riskfactors:-  “longloopofsigmoid”

-  Elongatedmesentery

-  Obs;pa;on

-  NeurologicaldisordersEndIO2016

SigmoidVolvulusTreatment

-  Endoscopicdetorsion-  Decompressiontube

-  Sigmoidectomy-PEC

SigmoidVolvulusPercutaneousEndoscopicColostomy

EndIO2016

Fixa;onofsigmoidloop-  OneortwoPEC

-  RemovalofPEC(ornot)

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%

Malignantcolonicobstruc;on

Survivalagersurgery

BrJSurg2006

Coloncancer

Mortalityageremergencysurgery

Endoscopy2014

Coloncancer

Surgicalprocedure

Coloncancer

DigSurg2015

Postopera;veoutcome

Coloncancer

DigSurg2015

Postopera;veoutcome

Coloncancer

DataJ.Vandervoort

OLV Cohort of stented patients Belgian Cancer Registry

Endoscopy2014

Endoscopy2014

AcuteColonicPseudo-obstruc;onOgilvieSyndrome

DisColonRectum2016

-  Dysregula;onofautonomicimpulsesinentericnervoussystem

-  Old,hospitalized/ins;tu;onalizedpa;ents

-  Progressiontoischemicperfora;on(3-15%)-  Cecaldila;on>12cm,leucocytosis,CRP,fever,…

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