Written transcription of Video Audio:
Video
Endoscopic treatment of sigmoid volvulus
An 80-year-old man presented with abdominal pain and distension, with no evidence of peritonitis on examination.
The medical history included:
Previous sigmoid volvulus, treated with endoscopic detorsion.
Palliative treatment of head and neck cancer.
Ischemic cardiomyopathy.
Those images correspond to a previous endoscopic detorsion of sigmoid volvulus 3 months ago.
This patient was not a candidate for surgical resection because of severe comorbidities.
A CT scan was done to exclude other causes of obstruction.
We can observe a distended sigmoid loop, with an inverted U position. This is the “coffee bean” sign.
In addition, we can notice a beak-shaped transition on sigmoid loop.
Laboratory exams showed normal values for white blood cell count, serum C - reactive protein, and electrolytes.
Water immersion technique is an option for sigmoid volvulus treatment.
This can be done with unsedated patients.
In this case, this is a good choice because of poor clinical conditions.
First, we noticed a torsion in the sigmoid colon, which is the classic “whirl sign.”
The procedure was initiated with a standard colonoscope, equipped with carbon dioxide insufflation and water pump.
No air insufflation was used.
The second attemptwas done inserting a guidewire across the volvulus, with a gentle push to pass the scope trough the volvulus.
In the third and final strategy, the guidewire was left in place and the colonoscope removed. A gastroscope was inserted over the guidewire, with assistance of an ERCP cannula.
After passing through the point of obstruction, the colon was decompressed, with endoscopic detorsion of the volvulus. The colon mucosa revealedischemic areas, with necrosis, without signs of perforation.
A rectal tube was left in place.
After endoscopic decompression and detorsion, there was a significant relief of the patient’s pain and abdominal distension, with no signs of peritonitis.
The oncology and surgical staffs, in accordancewith the family, decided for palliative treatment, with no surgical intervention because of poor clinical conditions and advanced metastatic neoplasia. The patient had fluid and electrolyte disturbances, with worsening of renal, pulmonary and cardiovascular conditions and died one day after endoscopic intervention
Endoscopic detorsion is a temporary measure for sigmoid volvulus treatment, because of high recurrence rate. This video illustrates tactics in decompression and detorsion of sigmoid volvulus