Sigmoid Kolon Torsiyonu: On Dokuz Olgunun Retrospektif Analizi

Year 2017, Volume: 14 Issue: 2, 117 - 123, 31.08.2017

Metin Yücel , Hakan Çakıt , Adnan Özpek Fatih Başak , Sema Yüksekdağ Aylin Acar , Ali Kılıç

Abstract

Amaç: Sigmoid kolon torsiyonu, tanı ve tedavisinde henüz
bir konsensusun sağlanamadığı, fakat geç kalındığında
yüksek oranda morbidite ve mortalite ile sonuçlanan acil
bir durumdur. Bu çalışmanın amacı, kliniğimizde sigmoid
kolon torsiyonu nedeniyle takip ve tedavi edilen hastaları
inceleyerek insidans ve uygun tedavi yaklaşımını
belirlemek idi.
Materyal ve Metod: Bu çalışma hastaların retrospektif
olarak taranması ile dizayn edildi. Hastaların tanısı fizik
muayene, ayakta direkt batın grafisi ve gereği halinde
bilgisayarlı tomografi ile konuldu. Resussitasyonu takiben
akut batın bulguları olan hastalara acil laparotomi, genel
durumu iyi ve stabil olan hastalara ise önce kolonoskopik
detorsiyon daha sonra semi-elektif veya elektif şartlarda
definitif cerrahi uygulandı. Hastaların demografik verileri,
insidansı, kolonoskopik detorsiyon ve uygulanan cerrahinin
sonuçları analiz edildi.
Bulgular: Çalışma süresi içinde intestinal obstrüksiyon
nedeniyle takip edilen 706 hastanın 19’u (%2,7) sigmoid
kolon torsiyonu idi. Bunların 13’ü erkek (%68,4), 6’sı
(%31,6) kadın olup yaş ortalaması 58.00 ±24 idi. On sekiz hastaya (%94,7) kolonoskopik detorsiyon denendi ve
17’sinde (%94,4) başarılı sonuç elde edildi. Kolonoskopik
detorsiyonun başarılı olduğu hastalardan 5’ine semi-elektif,
4’üne ise elektif şartlarda rezeksiyon ve primer anastomoz
yapıldı. Detorsiyonun başarılı olmadığı bir hastaya acil ve
rektal tüp uygulaması yapılan başka bir hastaya semielektif
şartlarda Hartman prosedürü uygulandı. Opere
edilen hastaların birinde (%9) nüks görülürken ameliyatı
kabul etmeyen 6 hastanın 4’ünde (%66,6) nüks gelişti.
Opere edilen hasta grubunda mortalite görülmezken opere
edilemeyen hasta grubunda 4 hasta (%50) mortal seyretti.
Opere edilmeyen hastalarda nüks ve mortalite istatistiksel
olarak anlamlı düzeyde yüksek bulundu (p=0,027, p=0,018
sırasıyla).
Sonuç: Sigmoid kolon torsiyonunda akut batın bulguları
yoksa ilk girişim olarak kolonoskopik detorsiyon,
sonrasında elektif veya semi-elektif şartlarda definitif
cerrahi uygun bir yaklaşımdır.

Keywords

Torsiyon, volvulus, endoskopik detorsiyon

Sigmoid Colon Torsion: Retrospective Analysis of Nineteen Cases

Abstract

Background: Sigmoid colon torsion is an emergency
situation for which there is no consensus for diagnosis and
treatment. The objective of this study is to determine the
incidence and appropriate treatment approach by analyzing
patients treated and followed up in our clinic for sigmoid
colon torsion.
Material and Methods: This study screened patients
retrospectively. The patients were diagnosed through
physical examination, standing abdominal X-ray, and
computerized tomography if required. Following
resuscitation, emergency laparotomy was performed for
patients with acute abdomen symptoms. Colonoscopic
detorsion and semi-elective or elective definitive surgery
were performed for stabilized patients. Demographic data,
incidence rates, colonoscopic detorsion results, and type of
surgery applied were analyzed.
Results: This study included a total of 19 patients,
13(68.4%) males and 6(31.6%) females with a mean age of
58.00±24. Colonoscopic detorsion was attempted for 18
patients (94.7%), and successful results were achieved in
17(94.4%). After successful colonoscopic detorsion, semielective
resection and primary anastomosis were performed
for 5 patients, while elective resection and primary
anastomosis were applied for 4 patients. Recurrences were
seen in one (9%) of the patients who underwent surgery
and in 4(66,6%) of the 6 patients who rejected the surgery.
No mortality was seen in the operated patient group,
whereas 4 patients (50%) died in the non-operated group.
Recurrence and mortality were statistically significantly
higher in the non-operated group (p=0.027, p=0.018 ,
respectively).
Conclusion: In cases with no symptoms for acute
abdomen, colonoscopic detorsion followed by elective or
semi-elective definitive surgery is an appropriate approach
for sigmoid colon torsion.
Key words: 

Keywords

Torsion, volvulus, endoscopic detorsion

References

• 1. Ören D, Selcuk S, Aydinli B, Yidirgan MI, Basoğlu M, Polat KY, et al. An algorithm for the management of sigmoid kolon volvulus and the safety of primary resection: Experience with 827 cases. Dis Colon Rectum 2007;50:489-97.
• 2. Heis HA, Bani-Hani KE, Rabadi DK, Elheis MA, BaniHani BK, Mazahreh TS, Bataineh ZA, Al-Zoubi NA, Obeidallah MS. Sigmoid volvulus in the Middle East. World J Surg 2008;32:459-64.
• 3. Madiba TE, Thomson SR. The management of sigmoid volvulus. J R Coll Surg Edinb 2000;45:74-80.
• 4. Tan KK, Chong CS, Sim R. Management of acute sigmoid volvulus: An institution's experience over 9 years. World J Surg 2010;34:1943-48.
• 5. Akinkuotu A, Samuel JC, Msiska N, Mvula C, Charles AG. The role of the Anatomy of the Sigmoid Colon in Developing Sigmoid Volvulus: A Case-Control Study. Clin Anat 2011;24(5):634-337.
• 6. Bagarani M, Conde A, Longo R. Sigmoid volvulus in West Africa: a prospective study on surgical treatments. Dis Colon Rectum 1993;36:186-90.
• 7. Raveenthiran V, Madiba TE, Atamanalp A, De U. Volvulus of the sigmoid colon. Colorectal Dis 2010;12(7 online):e1-17.
• 8. Mulas C, Bruna M, Garcia-Armengol J, Roig JV. Management of colonic volvulus. Experience in 75 patients. Rev Esp Enferm Dig 2010;102(4):239-48.
• 9. Valsdottir E, Marks JH. Volvulus: small bowel and colon. Clin Colon Rectal Surg 2008;21:91-3.
• 10. Turan M, Sen M, Karadayi K, Koyuncu A, Topcu O, Yildirir C, Duman M. Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process. Rev Esp Enferm Dig 2004;96:32-5.
• 11. Atamanalp SS, Yildirgan MI, Basoglu M, Kantarci M, Yılmaz I. Sigmoid colon volvulus in children: review of 19 cases. Pediatr Surg Int 2004;20:492-5.
• 12. Tiah L, Goh SH. Sigmoid volvulus: diagnostic twists and turns. Eur J Emerg Med 2006;13:84-7.
• 13. Sadahiro S, Ohmura T, Yamada Y, Saito T, Taki Y. Analysis of the length and surface area of each segment of the large intestine according to age, sex and physique. Surg Radiol Anat 1992;14:251-7.
• 14. Samuel JC, Akinkuotu A, Msiska N, Cairns BA, Muyco AP, Charles AG. Re-examining treatment strategies for sigmoid volvulus: An analysis of treatment and outcomes in Lilongwe, Malawi. Glob J Surg 2010;1(2):149-53.
• 15. Larkin JO, Thekiso TB, Waldron R, Barry K, Eustace PW. Recurrent sigmoid volvulus-early resection may obviate later emergency surgery and reduce morbidity and mortality. Ann R Coll Surg Engl 2009;91:205-9
• 16. Bhatnagar BN, Sharma CL, Gupta SN, Mathur MM, Reddy DCS. Study on the anatomical dimensions of the human sigmoid colon. Clin Anat 2004;17:236-43.
• 17. Burrell HC, Baker DM, Wardrop P, Evans AJ. Significant plain film findings in sigmoid volvulus. Clin Radiol 1994;49:317-9.
• 18. Feldman D. The coffee bean sign. Radiology 2000;216:178-9.
• 19. Levsky JM, Den EI, DuBrow RA, Wolf EL, Rozenblit AM. CT findings of sigmoid volvulus. AJR Am J Roentgenol 2010;194:136-43.
• 20. Grossmann E, Longo W, Stratton M. Sigmoid volvulus in department of veterans affairs medical centers. Dis Colon Rectum 2000;43:414-8.
• 21. Atamanalp SS, Oren D, Aydinli B, Ozturk G, Polat KY, Basoglu M, Yildirgan MI, Balik AA. Elective treatment of detorsioned sigmoid volvulus. Turk J Med Sci 2008;38:227-34.
• 22. Leong QM, Koh DC, Ho CK. Emergency Hartmann's procedure: morbidity, mortality and reversal rates among Asians. Tech Coloproctol 2008;12(1):21-5.
• 23. Raveenthiran V. Restorative resection of unprepared left-colon in gangrenous vs. viable sigmoid volvulus. Int J Colorectal Dis 2004;19:258-63.
• 24. Akcan A, Akyıldız H, Artis T. Feasibility of singlestage resection and primary anastomosis in patients with acute noncomplicated sigmoid volvulus. Am J Surg 2007;193:421-6.
• 25. Atamanalp SS, Aydınlı B, Öztürk G, Başoğlu M, Yıldırgan Mİ, Ören D, Kantarcı M. Classification of Sigmoid Volvulus. Turk J Med Sci 2008;38(5):425-9.
• 26. Yassaie O, Thompson-fawcett M, Rossaak J. Management of sigmoid volvulus: is early surgery justifiable?. ANZ J Surg 2013;83:74-8.