Sigmoid Volvulus

Colonic Decompression Tube

Fig. 24.5 Endoscopic placement of a decompression tube in the colon based on Seldinger technique (from 21). a Commercially available coaxial decompression tube from WilsonCook with guidewire. b Decompression tube with inner pilot wire to stiffen the tube. c Endoscopic intubation of the colon to the cecum. d Advancing the wire through the endoscope. Careful withdrawal of the instrument (under radiographic control), leaving the tip of the wire in the cecum.

The decompression tube with the inner guiding (stiffening) catheter wire is advanced (also under radiographic control) overthe guidewire already placed in the colon lumen. The wire is held firm with slight traction.

The tip of the decompression tube has reached the cecum. The inner pilot wire has thereafter to be carefully withdrawn (also under radiographic control).

Fig. 24.5 Endoscopic placement of a decompression tube in the colon based on Seldinger technique (from 21). a Commercially available coaxial decompression tube from WilsonCook with guidewire. b Decompression tube with inner pilot wire to stiffen the tube. c Endoscopic intubation of the colon to the cecum. d Advancing the wire through the endoscope. Careful withdrawal of the instrument (under radiographic control), leaving the tip of the wire in the cecum.

The decompression tube with the inner guiding (stiffening) catheter wire is advanced (also under radiographic control) overthe guidewire already placed in the colon lumen. The wire is held firm with slight traction.

The tip of the decompression tube has reached the cecum. The inner pilot wire has thereafter to be carefully withdrawn (also under radiographic control).

Decompress Colon
Fig. 24.6 Various models of decompression tubes from various manufacturers.

Mechanical Obstruction Volvulus

Pathogenesis. Colonic volvulus is a rotation of the colon around an often elongated mesocolon (Fig. 24.10). The sigmoid colon is most often affected (> 70%); the cecum and transverse colon are markedly less often affected. Colonic volvulus is a common cause of colonic obstruction in developing countries; elongation of the sigmoid due to the fiber-rich diet is thought to play a role etiopathogenically. In the western world, colonic volvulus is often associated with neurological diseases (Parkinson disease, multiple sclerosis, diseases of the spinal cord) and psychiatric disorders. In psychiatric disorders, it is the administration of psychopharmaceuticals with negative side effects on colonic motility that is blamed. Patients with severe constipation are also at risk.

Colonic Decompression Tube
Fig. 24.7 Anatomically adapted decompression tubes (based on 9) available from Bard for decompression of the descending colon (left), the transverse colon (center), and the ascending colon (right).
Colonoscopic Decompression
Fig. 24.8 Overtube (Olympus) serving as stiffener.
Colonoscopic Decompression

Improvement

Improvement

Improvement

Colonoscopic decompression

Improvement |

Cecostomy

Fig. 24.9 Algorithm for therapeutic approach in pseudo-obstruction of the colon.

Sigmoid Volvulus

Fig. 24.10 Volvulus in the sigmoid colon (based on 19). The sigmoid is twisted around its mesocolon, resulting in ischemia of the torsioned sigmoid colon.

Fig. 24.10 Volvulus in the sigmoid colon (based on 19). The sigmoid is twisted around its mesocolon, resulting in ischemia of the torsioned sigmoid colon.

Clinical picture. Patients present with abdominal pain, constipation, and gas. More than 50% of patients report similar prior attacks which spontaneously improved. Torsion of the affected colon segment and its mesentery results in obstructed passage and ischemia of the affected bowel. In a typical case radiologic diagnosis is not difficult. Abdominal radiography reveals a dis-

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