Large bowel volvulus.

A retrospective analysis of all patients presenting with colorectal volvulus and managed on a colorectal service in the University Department of Surgery, Wellington School of Medicine, over a 15 year period was undertaken. There were 13 males (58.6 yr.) and 11 females (55.8 yr.). The Maori to non Maori ratio was 1:1.76. Overall 19 patients had sigmoid volvulus. Thirteen patients were admitted as emergencies and eight of these had a sigmoid volvulus that could not be deflated endoscopically, four had a caecal volvulus and one had a volvulus of the ascending colon. Five right hemicolectomies, three Hartmann's procedures, one laparotomy and tube splintage and four sigmoid colectomies were performed in these 14 patients. Two patients were admitted semi-acutely and deflated endoscopically and nine patients were admitted electively. Four patients developed post operative respiratory problems and four patients developed urinary tract infections. No patient developed an anastomotic leak. There were no post operative deaths. Endoscopic reduction was not found to be useful in this series. It is suggested that patients admitted acutely with compromised bowel should have a Hartmann's operation and that primary resection remains the treatment of choice in all other patients.