What is the historical background of sigmoid and cecal volvulus?

Updated: Nov 28, 2018
  • Author: Scott C Thornton, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Before the 19th century, management of patients with volvulus was largely expectant. Gradually, as nonintervention became associated with a high mortality, early surgical treatment became a widely accepted practice.

By 1920, three surgical approaches (ie, open detorsion and mesenteric plication, resection with colostomy, and resection with anastomosis) were widely used for the surgical treatment of patients with sigmoid volvulus. Emergency resection carried a mortality of well over 50%. The Mikulicz operation, the Hartmann procedure, and sigmoidopexy combined with partial resections were also attempted, with variable results.

In 1947, the technique of transanal deflation of the volvulus using sigmoidoscopy was described. This method of treatment was supported by subsequent studies, [3] but nonoperative detorsion as the only treatment was found to be associated with a high recurrence rate. Consequently, elective resection after a few days of decompression of the colon was adopted, and this approach remains the current surgical treatment of patients with sigmoid volvulus.

Surgical treatment of cecal volvulus paralleled that of sigmoid volvulus. Before the early 19th century, expectant management was widely practiced; as experience accrued, surgical treatment became accepted. Detorsion and cecopexy were commonly performed, as was placement of cecostomy tubes. The high recurrence and complication rates led to the adoption of right hemicolectomy for the treatment of cecal volvulus, which remains the accepted approach. Cecostomy is reserved for patients who are too debilitated to withstand resection.


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