| Theme | Indications and Standards of Practice for Emergency Endoscopy | |
|---|---|---|
| Title | Volvulus of the Gastrointestinal Tract | |
| Publish Date | 2018/05 | |
| Author | Tatsuya Mikami | Division of Endoscopy, Hirosaki University Hospital |
| Author | Tomoyuki Aihara | Department of Internal Medicine, Hirosaki Municipal Hospital |
| Author | Miwa Satake | Department of Internal Medicine, Hirosaki Municipal Hospital / Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine |
| Author | Juichi Sakamoto | Department of Internal Medicine, Hirosaki Municipal Hospital |
| Author | Hiroshi Tono | Department of Internal Medicine, Hirosaki Municipal Hospital |
| Author | Shinsaku Fukuda | Division of Endoscopy, Hirosaki University Hospital / Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine |
| [ Summary ] | Volvulus of the gastrointestinal tract primarily affects the sigmoid colon and the coffee-bean sign noted on plain abdominal radiography is pathognomonic of this condition. Furthermore, it is necessary to perform abdominal CT to identify perforation and/or necrosis of the colonic wall. Emergency surgery is warranted if any such signs are identified. When performing colonic endoscopy, the instrument should be gently inserted through the anus, and the twisted narrow lumen should be observed in the sigmoid colon. After passing the scope across the twisted narrow lumen, air should be suctioned, and the scope should be advanced to the splenic flexure to correct the volvulus. Gastric volvulus is a rare disease entity, which is usually diagnosed on abdominal CT. Emergency surgery is required when a perforation and/or necrosis of the gastric wall has been identified. Initially, a nasogastric tube ought to be inserted to decompress the stomach. Next, an upper GI endoscopy is performed to evaluate the descending segment of the duodenum. Elective surgery should be considered in patients presenting with recurrent volvulus. |
|