Print ISSN: 2790-0207

Online ISSN: 2790-0215

Keywords : Acute large bowel volvulus

The Outcome of Emergency Surgery among Patients with Large Bowel Volvulus (LBV)

Amanj Mohammad Salih

Kirkuk Journal of Medical Sciences, 2016, Volume 4, Issue 1, Pages 25-35

Introduction: volvulus is a twisting or axial rotation of a portion of bowel about its mesentery. Large Bowel Volvulus (LBV) accounts for (5%) of all organic large bowel obstructions and are most common between 50 and 60 years of ages .The reported incidence of the various forms of LBV, (59%) for sigmoid volvulus (SV), (39%) for caecal volvulus (CV) and (2%) for transverse colon volvulus. The diagnosis of acute LBV can be challenging because its clinical presentation has low specificity compared with other non-traumatic abdominal pain. Emergency surgery is the appropriate treatment for those who present with diffuse peritonitis, intestinal perforation or ischemic necrosis. 
Aim of the study: To review the comparison and benefits of emergency operative procedures in the treatment of patients with acute large bowel volvulus in the emergency setting. 
Place and Duration: Department of General Surgery at Azadi-teaching hospital in Kirkuk city from December 2008 to December 2013. 
Patients and Methods: Total 48 patients; 31 male (64.6%) and 17 female (35.4%) (95.8%) patients were over 55 years of age. were included in the study of which 41 (85.4%) diagnosed preoperatively with acute sigmoid volvulus on emergency laparotomy. The remaining 7 patients (14.6%) with caecal volvulus. The choice of surgical procedure depended on the; large bowel viability, time of presentation following onset of obstructive features, extent of proximal colonic dilatation, co morbid diseases and surgeon’s preference. For acute sigmoid volvulus; 11 patient (27.2%) patients underwent sigmoid resection with primary anastomosis (RPA), 18 patient (43.9%) underwent Hartmann’s procedure and 12 patients (29.3%) operated by sigmoid resection with Paul-Mikulicz. For caecal volvulus; Right hemicolectomy performed for three patients (42.9%), caecopexy in two (28.6%) and caecostomy in other two patients (28.6%). Results: Abdominal distension and constipation occurs in all patients (100%), while (95.8%) presented with abdominal pain and peritonitis in (79.2%) (41.5%) has a previous history of bowel decompression either by endoscopic instruments or deflation by rectal tube with a recurrence rate of (76.0%). Chronic medical illnesses are found in most of the patients. LBV is presented in two forms sigmoid (85.4%) of cases, the rest (14.6%) with caecal volvulus. (33.4%) of cases presented with gangrenous colon while bowel perforation (fecal peritonitis) in (4.2%). The operative procedures ;- one stage Resection with Primary Anastomosis in (26.8%) of patients , two stage operative procedures resection of the volvulus sigmoid with (Hartmann and Paul-Mikulicz done in (73.2%), in caecal volvulus right hemicolectomy (with ileo-transverse Anastomosis done for (42.9%), caecopexy (28.6%) and Caecostomy for 2 patients(28.6%) patients. Postoperative complications; Wound infection in (31.3%) of cases. Anastomotic leak (12.5%). Total mortality occurs in 10 cases (20.8%). 
Conclusion: In acute LBV emergency surgery is indicated, Hartmann’s procedure is the procedure of choice. The presence of cardiac, renal, or respiratory diseases has a significant impact on the complications, morbidity and mortality of patients undergoing surgery for large bowel volvulus.