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Once the diagnosis of volvulus is made, the goal of treatment is to relieve the twisting of the intestine and prevent future episodes of twisting. The process of untwisting the intestines is called "reducing" the volvulus. In order to accomplish this, a flexible sigmoidoscopy is performed first.
What is the goal of treatment for volvulus?
Approach Considerations. In general, the treatment of an acute gastric volvulus remains emergency surgical repair.In patients who are not surgical candidates (secondary to comorbidities or an inability to tolerate anesthesia), endoscopic reduction may be attempted.
What are the approaches to the treatment of acute gastric volvulus?
In conclusion, colonoscopic decompression and derotation is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus and is a safe treatment modality for recurrent sigmoid volvulus.
What is the primary emergency treatment for Sigmoid volvulus?
Risk Factors. The risk factors for developing a volvulus include: Increasing age. Neuropsychiatric disorders. Resident in a nursing home. Chronic constipation or laxative use. Male gender. Previous abdominal operations.
What are the risk factors for volvulus?
Can onchocerciasis be cured?
The recommended treatment is ivermectin, which will need to be given every 6 months for the life span of the adult worms (i.e., 10–15 years) or for as long as the infected person has evidence of skin or eye infection. Ivermectin kills the larvae and prevents them from causing damage but it does not kill the adults.
Does river blindness still exist?
Onchocerciasis is currently relatively common in 31 African countries, Yemen, and isolated regions of South America. Over 85 million people live in endemic areas, and half of these reside in Nigeria. Another 120 million people are at risk for contracting the disease.
Is river blindness reversible?
By taking the drug frequently, the skin can partly heal. Unfortunately, for patients who lose all sight, blindness is irreversible because the optic nerve is damaged.
How do you prevent onchocerciasis?
How can I prevent onchocerciasis? Blackflies bite during the day. The best prevention is avoiding being bitten by infected blackflies by using insecticides that contain N,N-Diethyl-meta-toluamide (DEET) on exposed skin, wearing long sleeve shirts and pants, and wearing permethrin treated clothing.
Does ivermectin cure river blindness?
It is believed that ivermectin (a microfilaricide) could prevent blindness due to onchocerciasis. However, when given to everyone in communities where onchocerciasis is common, the effects of ivermectin on lesions affecting the eye are uncertain and data on whether the drug prevents visual loss are unclear.
Is there a vaccine for river blindness?
River blindness is typically treated with the anti-parasite medication ivermectin, and the World Health Organization (WHO) notes that in the absence of a vaccine to prevent these infections, the disease has been largely mitigated or eliminated through insecticide spraying and other methods.
Is onchocerciasis a communicable disease?
Is onchocerciasis contagious? Onchocerciasis is not contagious person to person. Transmission of the disease is through the bite of female blackflies (usually occurring during the daytime near rapidly flowing rivers and streams). Multiple bites are usually needed before being infected.
Can you feel onchocerciasis?
Onchocerciasis is an eye and skin disease. Symptoms are caused by the microfilariae, which move around the human body in the subcutaneous tissue and induce intense inflammatory responses when they die. Infected people may show symptoms such as severe itching and various skin changes.
What is the life cycle of onchocerciasis?
The larvae develop into adult worms in the nodules. Adult females may live up to about 15 years in these nodules. 4. After mating, mature female worms produce eggs, which develop into immature forms of the worm called microfilariae.
What control measures are used for onchocerciasis?
The best prevention efforts include personal protection measures against biting insects. This includes wearing insect repellant such as N,N-Diethyl-meta-toluamide (DEET) on exposed skin, wearing long sleeves and long pants during the day when blackflies bite, and wearing permethrin- treated clothing.
What is the epidemiology of onchocerciasis?
The Global Burden of Disease Study estimated that in 2017 there were at least 20.9 million people are infected worldwide, of which 14.6 million had skin disease and 1.15 million had vision loss.
How is onchocerciasis diagnosed?
Diagnosis. The gold standard test for the diagnosis of onchocerciasis remains the skin snip biopsy. The biopsy is performed using a sclerocorneal biopsy punch or by elevating a small cone of skin (3 mm in diameter) with a needle and shaving it off with a scalpel. This will result in the removal of around 2 mg of tissue ...
Symptoms of Sigmoid Volvulus
Sigmoid volvulus symptoms can be severe and occur suddenly. Symptoms may include 1. abdominal cramping 2. bloody stools 3. constipation 4. nausea 5...
Diagnosis and Treatment of Sigmoid Volvulus
Prompt diagnosis and appropriate treatment of sigmoid volvulus generally lead to a successful outcome. Doctors use x rays, upper or lower GI series...
Symptoms of Cecal Volvulus
More commonly seen in people ages 30 to 60, cecal volvulus may be caused by abdominal adhesions, severe coughing, or pregnancy. People with cecal v...
Diagnosis and Treatment of Cecal Volvulus
Doctors use x rays, upper or lower GI series, and CT scans to diagnose cecal volvulus. Imaging shows whether the cecum is out of place and inflated...
How to diagnose a cecal volvulus?
Doctors use x rays, upper or lower GI series, and CT scans to diagnose cecal volvulus. Imaging shows whether the cecum is out of place and inflated with trapped air. Imaging may also show that the appendix, which is attached to the cecum, is filled with air. To treat cecal volvulus, surgeons use a procedure called cecopexy to reposition the cecum and attach it to the abdominal wall. If the cecum is seriously damaged by volvulus, the surgeon will perform intestinal resection surgery. Cecopexy and intestinal resection surgery have high rates of success and usually prevent the recurrence of cecal volvulus.
Why do I have cecal volvulus?
More commonly seen in people ages 30 to 60, cecal volvulus may be caused by abdominal adhesions, severe coughing, or pregnancy. People with cecal volvulus often have intermittent chronic symptoms—those that come and go over a longer period of time—including
What test is used to diagnose sigmoid volvulus?
Prompt diagnosis and appropriate treatment of sigmoid volvulus generally lead to a successful outcome. Doctors use x rays, upper or lower GI series, CT scans, and flexible sigmoidoscopy— another common diagnostic test—to help diagnose sigmoid volvulus.
Can sigmoid volvulus be severe?
Sigmoid volvulus symptoms can be severe and occur suddenly. Symptoms may include. People with any of these symptoms should be evaluated immediately by a health care provider. Other symptoms may develop more slowly but worsen with time, such as constipation, inability to pass gas, and abdominal swelling.
Can a child be given a sedative for a volvulus test?
Infants and children may be given a sedative to help them fall asleep for the test. For the test, the person will lie on a table while the doctor inserts a flexible tube into the anus. A small camera on the tube sends a video image of the intestinal lining to a computer screen. The doctor can see sigmoid volvulus.
Can you see volvulus after a colonoscopy?
Children and adults can usually go back to their normal diet after the test, though cramping or bloating may occur during the first hour after the test. If volvulus is found, the doctor may use the sigmoidoscope to untwist the colon .
What is volvulus treatment?
Volvulus Treatment. Volvulus is defined as an intestinal blockage that makes the bowel passage restrict the flow of the waste material. Treatment for volvulus is the key to delineate the problem. Volvulus is defined as an intestinal blockage that makes the bowel passage restrict the flow of the waste material.
What is the treatment for sigmoid volvulus?
The treatment for sigmoid volvulus and cecal volvulus involves a procedure called colonoscopy. Colonoscopy procedure can be defined as a medical procedure where the colon is excavated through the means of a medical equipment. This equipment is inserted through the rectum, proceeding further into the affected area and examining ...
What is volvulus in bowel?
Volvulus is defined as an intestinal blockage that makes the bowel passage restrict the flow of the waste material. Treatment for volvulus is the key to delineate the problem. To begin with, it is important to elucidate what is volvulus.
What is the midgut volvulus?
The mid-gut volvulus is a serious condition where the mid-gut convolutes entirely around the mesenteric artery. The symptoms that indicate the occurrence of volvulus is abdominal pain, nausea, severe constipation and blood in stool.
Is sigmoid volvulus treated with cecal volvulus?
Sigmoid volvulus treatment and cecal volvulus treatment derive solution from one single remedy, and that’s undergoing a surgical procedure. Repairing the volvulus is essential in elementary stages of detection of the said condition.
Can constipation cause sigmoid volvulus?
Constipation over a long period of time can cause the sigmoid colon to lengthen in an abnormal manner. One needs to bear in mind that sigmoid volvulus can be a fatal condition to endure, if left untreated. Gangrene, a condition that is caused by possible tissue death, can occur if not treated promptly.
Is volvulus a problem?
Understanding volvulus thoroughly is a prerequisite to comprehending the volvulus treatment. Volvulus is a serious large intestine problem. The loop of the intestine becomes convoluted thereby resulting in a bowel obstruction, due to which the passage is blocked. The twist can pound on any site of the Gastrointestinal tract ...
What is the management of a caecal volvulus?
The management of a caecal volvulus is always laparotomy and ileocaecal resection (assuming the patient is well enough). [start-clinical] Key Points. Sigmoid volvulus are common in those from a nursing home, have dementia, or suffer with chronic constipation.
How to treat sigmoid volvulus?
Most patients with sigmoid volvulus are treated conservatively initially with decompression by sigmoidoscope and insertion of a flatus tube. In sigmoidoscope decompression, the patient is placed in the left lateral position and a lubricated sigmoidoscope gently guided into the rectum.
What are the complications of sigmoid volvulus?
Complications. The main immediate complication of a sigmoid volvulus is of bowel ischaemia and perforation . Longer term complications are mainly the risk of recurrence (occurring in up to 90% of patients) and complications from a stoma if placed.
What is a volvulus?
A volvulus is the twisting of a loop of intestine * around its mesenteric attachment, resulting in a closed loop bowel obstruction. The affected bowel can become ischaemic due to a compromised blood supply, rapidly leading to bowel necrosis and perforation.
How long does a flatus tube stay in place?
A flatus tube is often left in situ for a period of time (up to 24 hours) after initial decompression to allow for the continued passage of contents and aid recovery of the affected area. In 25-50% of patients, this approach is unsuccessful and a formal decompression with a flexible sigmoidoscope is required.
Where can volvulus occur?
They can also occur at the stomach, caecum, small intestine and transverse colon , but are much rarer. The long mesentery of the sigmoid colon (which increases with age) means that this segment bowel is more prone to twisting on its mesenteric base (Fig. 1) to form a volvulus than any other region.
What age group is a bimodal onset?
There is a bimodal age of onset, in the 10-29 year group and then again in the 60-79 year group. Those in the younger group may have intestinal malformation or excessive exercise as the predisposing cause, whilst in older patients it is more associated with chronic constipation, distal obstruction, or dementia.
Should a surgeon exercise clinical judgment?
The surgeon should also exercise clinical judgment and make sure that the patient is optimized and resuscitated before the operation. Some authors have advocated consideration of emergency endoscopic reduction in the setting of acute gastric volvulus in patients who are at high risk for surgery. [ 36] . This strategy may allow the patient ...
Can chronic gastric volvulus be treated?
Chronic gastric volvulus may be treated on a nonemergency basis, and surgical treatment is increasingly being performed via a laparoscopic approach. A review of patients with chronic gastric volvulus who were managed conservatively reported a high recurrence rate but very few serious complications.
Can gastric volvulus be treated laparoscopically?
With advances in laparoscopic surgery, most cases of acute and chronic gastric volvulus can now be approached laparoscopically. In the absence of peritonitis or an unstable patient, most cases can be adequately treated in this way.
Is gastric volvulus a surgical emergency?
Emergency surgical intervention is indicated for acute gastric volvulus, which is still considered a surgical emergency by many surgeons. With chronic gastric volvulus, surgery is performed to prevent complications. The principles associated with the treatment of gastric volvulus include decompression, reduction, and prevention of recurrence, ...
Is gastric volvulus endoscopic?
Endoscopic Treatment. Although the treatment of gastric volvulus is surgical, advances in laparoscopic surgery have also been accompanied by advances in therapeutic endoscopy, with several reports of endoscopic treatment of acute gastric volvulus. [ 36, 29, 45, 46, 47, 48, 49, 50] However, the majority of cases describing endoscopic management ...
Why do boys have volvulus?
However, more boys have symptoms by the first month of life than girls. A volvulus is a problem that can occur after birth as a result of intestinal malrotation. The intestine becomes twisted, causing an intestinal blockage that prevents food from being digested normally. This blockage can also cause dehydration.
Why do children need IV fluids?
Children may be started on IV (intravenous) fluids to prevent dehydration and antibiotics to prevent infection. A tube called a nasogastric (or NG) tube may be guided from the nose, through the throat and esophagus, to the stomach to prevent gas buildup in the stomach.
What is the procedure for malrotation?
Evaluation and diagnosis. In addition to a physical exam and medical history, diagnostic procedures for malrotation and volvulus may include various imaging studies (tests that show pictures of the inside of the body). These are done to evaluate the position of the intestine, and whether it is twisted or blocked.
Can a volvulus be repaired?
A volvulus is usually surgically repaired as soon as possible. The intestine is untwisted and checked for damage. Ideally, the circulation to the intestine will be restored after it is unwound, and it will turn pink. If the intestine is healthy, it is replaced in the abdomen.
Can volvulus damage be long term?
Long-term outlook. The majority of children with malrotation who experienced a volvulus do not have long-term problems if the volvulus was repaired promptly and there was no intestinal damage. Children with intestinal injury who had the damaged part removed may have long-term problems.
What is sigmoid volvulus?
sigmoid volvulus is often encountered in older patients, some of whom may be unfit for abdominal operations. for this subset of patients, a number of small case series have in-vestigated advanced endoscopic techniques as a less invasive means to prevent recurrent sigmoid volvulus. the percuta-neous endoscopic colostomy (PeC) technique is performed to fix the sigmoid colon to the anterior abdominal wall, re-stricting its mobility, with the aim of preventing recurrent volvulus. fixation of the colon has been performed using t fasteners or by percutaneous tube colostomy placement with or without laparoscopic assistance.14,85–90 although the literature includes a few reports of small case series, 1 relatively large study included 19 elderly patients with re-current sigmoid volvulus who were judged unfit for defini-tive surgical treatment.85 in that study, the PeC procedure was successfully performed in all of the patients, whereas major complications (including peritonitis, tube migra-tion, and death) occurred in 2 patients (10%) and minor complications (eg, abdominal wall bleeding or infection) occurred in 7 patients (37%). there were 8 deaths from un-related causes. of the 6 patients who underwent removal of the PeC tube(s), after 6 to 26 months of fixation, none experienced recurrent volvulus at a median follow-up of 35 months. in another series of 14 patients, PeC maintained reduction of the volvulus in each of the 5 patients in whom it was left in place but in only 3 of 6 in whom the PeC was subsequently removed.86 at present, it appears that PeC may be a useful tool for the treatment of sigmoid volvu-lus, but more studies are needed to assess its durability. for the time being, it should generally be reserved for patients in whom established operative interventions are judged to pose a prohibitive degree of risk.
What grade of endoscopy is recommended for a sesigmoid colon?
1. Rigid or flexible endoscopy should be performed to as-sesssigmoid colon viability and to allow initial detorsion and decompression of the colon. Grade of Recommen-dation: Strong recommendation, based on low- or very-low-quality evidence, 1C.