Colonic Volvulus - Liebermans eRadiology （结肠肠扭结-利伯曼eRadiology）.pdfVIP

Colonic Volvulus Tamim Qaum Harvard Medical School, Year III Definition • Torsion of the colon around its mesenteric axis, leading to 1) Compromised blood flow, and 2) A closed loop obstruction • Dual mechanism of infarction: 1) Torsion of vessels stops flow of blood to colonic wall. 2) Torsion of colon creates closed loop obstruction (with venous obstruction, luminal secretion, and colonic wall distention leading to arterial obstruction). • Anatomic requirements: 1) Redundant segment of freely movable bowel. 2) Proximity of points of fixation of the bowel. Epidemiology of Volvulus • Incidence: 2 per 100,000 • Accounts for 25% of obstruction cases in pregnancy because uterus displaces all mobile segments of colon. • Sigmoid volvulus = 75-80%. • Cecal volvulus = 20-25%. • Tranverse colon volvulus = 3% (70 cases); uncommon because of short, broad attachment of colonic mesentery. • Splenic flexure volvulus = 1-2% (30 cases); risk factors: absence of gastrosplenic, splenocolic, phrenicoloic ligaments. • Stomach, gallbladder, and small bowel volvulus are rare. Epidemiology of Sigmoid Volvulus • In the United States, sigmoid volvulus accounts for 10% of intestinal obstruction cases. • In Bolivian and Peruvian Andes, sigmoid volvulus accounts for 80% of intestinal obstruction cases. • In US and Western Europe, sigmoid volvulus is associated with chronic constipation and laxative abuse (develop megacolon with maximal dilation of sigmoid); no gender difference. • In developing countries, sigmoid volvulus is associated with diets high in vegetable fiber (90% of pts are men). Epidemiology of Sigmoid Volvulus • Elderly patients (average age: 72) . 40% insti