Volvulus of the colon. A review of 93 cases and current aspects of treatment.

Ninety-three patients, comprising a consecutive, population-based series, were treated for volvulus of the colon between 1970 and 1985. The male:female ratio was 3.3:1 among the patients with volvulus of the sigmoid colon and 1:3.7 among those with caecal volvulus (p less than 0.001). Of the 60 patients with sigmoid volvulus, nine (15%) died. Elective surgery was performed in 13 of these 60 cases, without postoperative mortality. Previous volvulus attack(s) had occurred in 22 of the 60. Of the nine patients who underwent only detorsion at laparotomy, four had recurrence. Of the 33 patients with caecal volvulus, 31 underwent emergency laparotomy, and in seven of them the outcome was fatal. Of the nine patients who survived pexis operations, three had recurrence of volvulus. The results indicate that immediate laparotomy can be hazardous in patients with colonic volvulus. Semi-emergency resection after tube decompression, when the patient is in optimal condition and with preoperatively prepared bowel, is probably preferable.