2010年3月29日 星期一
Posted in
GI
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0
意見
Sigmoid volvulus乙狀結腸扭結為一"腹部急症"﹐一旦診斷確定﹐須立即治療﹐
否則一旦腸壞死﹐則死亡率會大幅升高。
UpToDate:
The goals of treatment of sigmoid volvulus are to prevent the development of gangrene and to address the anatomic abnormality that led to the volvulus. In patients who do not have clinical features suggestive of gangrene or perforation, we suggest "flexible sigmoidoscopy" in an attempt to detorse the twisted segment (Grade 2B). Following successful detorsion, we suggest leaving a rectal tube in place (Grade 2C).
"Recurrent" volvulus develops in about "50 to 60 percent" of patients. As a result, we suggest surgery to prevent recurrence (Grade 2C). We generally perform a mechanical bowel prep and then a standard open laparotomy with sigmoid resection and primary anastomosis. Exceptions are patients in whom definitive surgical therapy is considered to be associated with prohibitive risks. (See 'Treatment' above.)
