NON-SURGICAL REPLACEMENT OF SIGMOID VOLVULUS UNDER THE COLONOSCOPIC CONTROL

Abstract

A fiberoptic colonoscope was used for the treatment of sigmoid volvulus. In 5 patients with sigmoid volvulus, treatment under colonoscopic control were performed in 10 times from 1977 to 1980. Four were female and one was male. Their ages ranged from 31 to 72 years old and the mean age was 49.4 years old at first episode of volvulus. The symptomatic period before admission ranged from 2 to 7 days and averaged 4.9 days. The main symptom was abdominal fullness and prominent physical finding was abdominal distension in all cases. Four of five patients had significant neurologic or psychiatric disorder. A plain X-ray film of abdomen taken at the time of admission revealed remarkable sigmoid volvulus in all cases. One patient revealed mild leucocytosis, but remaining four did not show any imflammatory evidence in blood cell count and serum chemistry. Saline enema was given as intial treatment in every cases, but all failed to replace the volvulus. A colonoscope was immediately introduced for the purpose of gas reduction. In one patient, the colonoscope was inserted into the splenic flexura and a double stiffening tube was introduced along the colonoscope after straighting the sigmoid colon. That tube was left for 12 hours to prevent recurrence of volvulus. In the remaining cases the excess gas in the extended colon was attempted to be removed. Elective sigmoid resections were performed in 2 patients who were suspected of presense of gangrenous change on bowel wall and recurrence. The remaining 3 patients were followed without surgery, 2 cases of them had no episode of recurrence since then and one patient recurred 5 times during the following 2 years. If neither signs of peritonitis nor gangrene are present, replacement using a colonoscope should be actively attemped as an initial therapeutic approach.