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==Overview==
==Overview==
The epidemiological data found on volvulus is scarce, however, acute mechanical small bowel obstruction is a common surgical emergency. It is estimated that over 300,000 laparotomies are performed per year in the United States for adhesion-related obstructions such as volvulus .  
Acute mechanical small bowel obstruction is a common [[surgical emergency]] where volvulus is the cause in 10% of cases. It is estimated that over 300,000 [[Laparotomy|laparotomies]] are performed per year in the United States for adhesion-related obstructions such as volvulus. Volvulus originating in the colon is the third most common cause of large bowel obstruction.


==Epidemiology and Demographics==
==Epidemiology and Demographics==


===Incidence===
===Incidence===
*The incidence of volvulus is approximately 2 per 100,000 individuals worldwide.
*The incidence of volvulus is approximately 2 per 100,000 individuals worldwide.<ref name="pmid19469008">{{cite journal |vauthors=Katoh T, Shigemori T, Fukaya R, Suzuki H |title=Cecal volvulus: report of a case and review of Japanese literature |journal=World J. Gastroenterol. |volume=15 |issue=20 |pages=2547–9 |year=2009 |pmid=19469008 |pmc=2686916 |doi= |url=}}</ref><ref name="pmid16344301">{{cite journal |vauthors=Consorti ET, Liu TH |title=Diagnosis and treatment of caecal volvulus |journal=Postgrad Med J |volume=81 |issue=962 |pages=772–6 |year=2005 |pmid=16344301 |pmc=1743408 |doi=10.1136/pgmj.2005.035311 |url=}}</ref><ref name="pmid4015215">{{cite journal |vauthors=Ballantyne GH, Brandner MD, Beart RW, Ilstrup DM |title=Volvulus of the colon. Incidence and mortality |journal=Ann. Surg. |volume=202 |issue=1 |pages=83–92 |year=1985 |pmid=4015215 |pmc=1250842 |doi= |url=}}</ref><ref name="pmid23511842">{{cite journal |vauthors=Halabi WJ, Jafari MD, Kang CY, Nguyen VQ, Carmichael JC, Mills S, Pigazzi A, Stamos MJ |title=Colonic volvulus in the United States: trends, outcomes, and predictors of mortality |journal=Ann. Surg. |volume=259 |issue=2 |pages=293–301 |year=2014 |pmid=23511842 |doi=10.1097/SLA.0b013e31828c88ac |url=}}</ref><ref name="pmid20006232">{{cite journal |vauthors=Wu MH, Chang YC, Wu CH, Kang SC, Kuan JT |title=Acute gastric volvulus: a rare but real surgical emergency |journal=Am J Emerg Med |volume=28 |issue=1 |pages=118.e5–7 |year=2010 |pmid=20006232 |doi=10.1016/j.ajem.2009.04.031 |url=}}</ref>
*Sigmoid volvulus has the highest incidence accounting for 75 - 80% of volvulus cases
*Sigmoid volvulus has the highest incidence, followed by cecal volvulus.
*Cecal volvulus has the second highest incidence accounting for 20 - 25% of volvulus cases.
*The incidence of cecal volvulus increases per year, whereas the incidence of sigmoid volvulus remains stable.
*The incidence of cecal volvulus increases by 5.53 percent per year, whereas the incidence of sigmoid volvulus remains stable.
*The incidence of volvulus is higher in those that live in nursing homes or are institutionalized. These patients usually take psychotropic drugs that interfere with colonic motility and can increase the incidence of volvulus.
*In other studies, the incidence of cecal volvulus ranges from 2.8 to 7.1 per million people per year.
*The incidence of gastric volvulus is rare.
*The incidence of gastric volvulus is rare.


 
===Prevalence===  
===Prevalence===
*In 2002 - 2010, the prevalence of colonic volvulus is estimated to be 63,749 cases in the United States annually.<ref name="pmid23511842">{{cite journal |vauthors=Halabi WJ, Jafari MD, Kang CY, Nguyen VQ, Carmichael JC, Mills S, Pigazzi A, Stamos MJ |title=Colonic volvulus in the United States: trends, outcomes, and predictors of mortality |journal=Ann. Surg. |volume=259 |issue=2 |pages=293–301 |year=2014 |pmid=23511842 |doi=10.1097/SLA.0b013e31828c88ac |url=}}</ref>
In an epidemiologic study, 63,749 cases of colonic obstruction were admitted in the United States from 2002 to 2010 [14]. .
*In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
*The prevalence of [disease/malignancy] is estimated to be [number] cases annually.


===Case-fatality rate/Mortality rate===
===Case-fatality rate/Mortality rate===
*In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate/mortality rate of [number range]%.
*The mortality rate of volvulus is 7 per 100 cases.<ref name="pmid4015215">{{cite journal |vauthors=Ballantyne GH, Brandner MD, Beart RW, Ilstrup DM |title=Volvulus of the colon. Incidence and mortality |journal=Ann. Surg. |volume=202 |issue=1 |pages=83–92 |year=1985 |pmid=4015215 |pmc=1250842 |doi= |url=}}</ref>
*The case-fatality rate/mortality rate of [disease name] is approximately [number range].


===Age===
===Age===
Sigmoid volvulus usually occurs in older adults with a mean age of 70 years at presentation [5].  
*The incidence of volvulus increases with age; the median age at diagnosis is 70 years.<ref name="pmid23511842">{{cite journal |vauthors=Halabi WJ, Jafari MD, Kang CY, Nguyen VQ, Carmichael JC, Mills S, Pigazzi A, Stamos MJ |title=Colonic volvulus in the United States: trends, outcomes, and predictors of mortality |journal=Ann. Surg. |volume=259 |issue=2 |pages=293–301 |year=2014 |pmid=23511842 |doi=10.1097/SLA.0b013e31828c88ac |url=}}</ref><ref name="pmid3655280">{{cite journal |vauthors=Krupsky S, Halevy A, Orda R |title=Sigmoid volvulus in adolescence |journal=J. Clin. Gastroenterol. |volume=9 |issue=4 |pages=467–9 |year=1987 |pmid=3655280 |doi= |url=}}</ref><ref name="pmid20006232">{{cite journal |vauthors=Wu MH, Chang YC, Wu CH, Kang SC, Kuan JT |title=Acute gastric volvulus: a rare but real surgical emergency |journal=Am J Emerg Med |volume=28 |issue=1 |pages=118.e5–7 |year=2010 |pmid=20006232 |doi=10.1016/j.ajem.2009.04.031 |url=}}</ref>
Sigmoid volvulus has been reported in younger patients and in children in association with abnormal colonic motility [15-20]. (See 'Colonic dysmotility' below.)
*Sigmoid volvulus has been reported in children and adolescents and is usually associated with abnormal [[Peristalsis|colonic peristalsis]].
astric volvulus is rare. The incidence peaks after the fifth decade with adults constituting 80 to 90 percent of cases
*Gastric volvulus is rare and the incidence peaks after the fifth decade.  
*Patients of all age groups may develop [disease name].
*The incidence of neonatal and infantile volvulus is unknown since non-rotation or malrotation of the gut may remain asymptomatic throughout life.<ref name="Burns2006">{{cite journal|last1=Burns|first1=Cartland|title=Principles and Practices of Pediatric Surgery|journal=Annals of Surgery|volume=243|issue=4|year=2006|pages=567|issn=0003-4932|doi=10.1097/01.sla.0000208423.52007.38}}</ref>
*The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
**In the United States, non-rotation is an incidental finding in 2 out of 1000 upper gastrointestinal contrast studies.
*[Disease name] commonly affects individuals younger than/older than [number of years] years of age.  
**In the United States, symptomatic malrotation in neonates occurs in 1 in 6000 live births.  
*[Chronic disease name] is usually first diagnosed among [age group].
*[Acute disease name] commonly affects [age group].


===Race===
===Race===
A longer sigmoid colon and mesentery in males (especially in black Africans) could be the reason for an increased likelihood of volvulus [22,23].  
*Volvulus usually affects individuals of the Black race.<ref name="pmid26112767">{{cite journal |vauthors=Madiba TE, Aldous C, Haffajee MR |title=The morphology of the foetal sigmoid colon in the African population: a possible predisposition to sigmoid volvulus |journal=Colorectal Dis |volume=17 |issue=12 |pages=1114–20 |year=2015 |pmid=26112767 |doi=10.1111/codi.13042 |url=}}</ref><ref name="pmid26435933">{{cite journal |vauthors=Michael SA, Rabi S |title=Morphology of Sigmoid Colon in South Indian Population: A Cadaveric Study |journal=J Clin Diagn Res |volume=9 |issue=8 |pages=AC04–7 |year=2015 |pmid=26435933 |pmc=4576524 |doi=10.7860/JCDR/2015/13850.6364 |url=}}</ref>
*There is no racial predilection to [disease name].
**Black individuals are at increased risk for volvulus because they tend to have a longer [[mesentery]] and [[sigmoid colon]].
*[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
 
===Gender===
===Gender===
==Gastric Volvulus==
*Most studies have found that volvulus affects men and women equally.<ref name="pmid2929205">{{cite journal |vauthors=Påhlman L, Enblad P, Rudberg C, Krog M |title=Volvulus of the colon. A review of 93 cases and current aspects of treatment |journal=Acta Chir Scand |volume=155 |issue=1 |pages=53–6 |year=1989 |pmid=2929205 |doi= |url=}}</ref><ref name="pmid7861341">{{cite journal |vauthors=Baker DM, Wardrop PJ, Burrell H, Hardcastle JD |title=The management of acute sigmoid volvulus in Nottingham |journal=J R Coll Surg Edinb |volume=39 |issue=5 |pages=304–6 |year=1994 |pmid=7861341 |doi= |url=}}</ref><ref name="pmid8739835">{{cite journal |vauthors=Isbister WH |title=Large bowel volvulus |journal=Int J Colorectal Dis |volume=11 |issue=2 |pages=96–8 |year=1996 |pmid=8739835 |doi= |url=}}</ref>
G[5]. No association with sex or race has been reported.
*Although some studies have found a predominance in men, cecal volvulus has been found to be more prevalent in younger females.
cecal volvulus was more prevalent in younger females.
 
Although some series have reported a predominance in men, others have found no difference in incidence by gender [4,13,21].
*[Disease name] affects men and women equally.
*[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
===Region===
===Region===
*The majority of [disease name] cases are reported in [geographical region].
*The majority of volvulus cases are reported in Russia, India, Iran, Norway and Africa.<ref name="pmid4015215">{{cite journal |vauthors=Ballantyne GH, Brandner MD, Beart RW, Ilstrup DM |title=Volvulus of the colon. Incidence and mortality |journal=Ann. Surg. |volume=202 |issue=1 |pages=83–92 |year=1985 |pmid=4015215 |pmc=1250842 |doi= |url=}}</ref>
The incidence of sigmoid volvulus is not well established (picture 1). In the United States, sigmoid volvulus is a relatively uncommon cause of intestinal obstruction, representing fewer than 10 percent of cases in most series [1,5]. In contrast, sigmoid volvulus is the underlying etiology in 50 to 80 percent of patients with intestinal obstruction in other parts of the world [6-10]. (See "Chagas disease: Pathology and pathogenesis".)
*In the United States, volvulus only accounts for 0.1 of cases with intestinal obstruction.
*[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].
 
===Developed Countries===
 
===Developing Countries===
 
 
 
 
 
 
 
 
==Neonatal and Infantile volvulus==
 
Rotational anomalies occur as a result of an arrest of normal rotation of the embryonic gut. Because rotational anomalies may remain asymptomatic throughout a person’s life span, the true incidence is not known. Nonrotation, a type of malrotation is an incidental finding on approximately 2 out of 1000 upper gastrointestinal contrast studies [1]. Symptomatic malrotation in neonates occurs with a frequency of about 1 in 6000 live births.
 
Traditionally, intestinal malrotation has been considered primarily a disease of infancy with infrequent occurrence beyond the first year of life [2,3]. However, analysis of 2744 cases of intestinal rotation in children up to 17 years of age obtained from a national hospital discharge database found the following [2]:
 
●Presentation by one month of age: 30 percent
 
●Presentation before one year of age: 58 percent
 
●Presentation before five years of age: 75 percent
 
Similarly, in a series of 170 patients of all ages with symptomatic intestinal malrotation managed at a single institution, age distribution at time of presentation was as follows [3]:
 
●Infants under one year of age: 31 percent
 
●Children 1 to 18 years of age: 21 percent
 
●Adults over 18 years of age: 48 percent
 
Thus, the prevalence of malrotation in children over one year of age and adults appears to be higher than previously thought.
 
Associated congenital defects — Up to 62 percent of children who have intestinal malrotation have an associated anomaly (table 1) [4-7].
 
Based upon a systematic review of small, single-institution studies, the following conditions have demonstrated a strong association with intestinal malrotation [8]:
 
●Congenital diaphragmatic hernia – Up to 100 percent
 
●Congenital heart disease, especially heterotaxy syndrome – 40 to 90 percent (see 'Screening' below)
 
●Omphalocele – 31 to 45 percent
 
Intestinal malrotation is also associated with:
 
●Gastroschisis (see "Gastroschisis", section on 'Associated anomalies and findings')
 
●Prune belly syndrome (see "Prune-belly syndrome", section on 'Abdominal wall and gastrointestinal tract')
 
●Certain types of intestinal atresias [9] (see "Intestinal atresia")
 
●Esophageal atresia (solitary and with tracheoesophageal fistula) [10]
 
●Biliary atresia in patients with laterality malformations (see "Biliary atresia", section on 'Types of biliary atresia')
 
●Meckel diverticulum [11]


●Complex anorectal malformations or anorectal malformations with 2 or more anomalies of the VACTERL (vertebral, anal, cardiac, tracheoesophageal, renal, limb) complex [12,13]


●Cornelia de Lange syndrome [14]


==References==
==References==

Latest revision as of 15:00, 9 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: ; Hadeel Maksoud M.D.[2]


Overview

Acute mechanical small bowel obstruction is a common surgical emergency where volvulus is the cause in 10% of cases. It is estimated that over 300,000 laparotomies are performed per year in the United States for adhesion-related obstructions such as volvulus. Volvulus originating in the colon is the third most common cause of large bowel obstruction.

Epidemiology and Demographics

Incidence

  • The incidence of volvulus is approximately 2 per 100,000 individuals worldwide.[1][2][3][4][5]
  • Sigmoid volvulus has the highest incidence, followed by cecal volvulus.
  • The incidence of cecal volvulus increases per year, whereas the incidence of sigmoid volvulus remains stable.
  • The incidence of volvulus is higher in those that live in nursing homes or are institutionalized. These patients usually take psychotropic drugs that interfere with colonic motility and can increase the incidence of volvulus.
  • The incidence of gastric volvulus is rare.

Prevalence

  • In 2002 - 2010, the prevalence of colonic volvulus is estimated to be 63,749 cases in the United States annually.[4]

Case-fatality rate/Mortality rate

  • The mortality rate of volvulus is 7 per 100 cases.[3]

Age

  • The incidence of volvulus increases with age; the median age at diagnosis is 70 years.[4][6][5]
  • Sigmoid volvulus has been reported in children and adolescents and is usually associated with abnormal colonic peristalsis.
  • Gastric volvulus is rare and the incidence peaks after the fifth decade.
  • The incidence of neonatal and infantile volvulus is unknown since non-rotation or malrotation of the gut may remain asymptomatic throughout life.[7]
    • In the United States, non-rotation is an incidental finding in 2 out of 1000 upper gastrointestinal contrast studies.
    • In the United States, symptomatic malrotation in neonates occurs in 1 in 6000 live births.

Race

  • Volvulus usually affects individuals of the Black race.[8][9]
    • Black individuals are at increased risk for volvulus because they tend to have a longer mesentery and sigmoid colon.

Gender

  • Most studies have found that volvulus affects men and women equally.[10][11][12]
  • Although some studies have found a predominance in men, cecal volvulus has been found to be more prevalent in younger females.

Region

  • The majority of volvulus cases are reported in Russia, India, Iran, Norway and Africa.[3]
  • In the United States, volvulus only accounts for 0.1 of cases with intestinal obstruction.


References

  1. ↑ Katoh T, Shigemori T, Fukaya R, Suzuki H (2009). "Cecal volvulus: report of a case and review of Japanese literature". World J. Gastroenterol. 15 (20): 2547–9. PMC 2686916. PMID 19469008.
  2. ↑ Consorti ET, Liu TH (2005). "Diagnosis and treatment of caecal volvulus". Postgrad Med J. 81 (962): 772–6. doi:10.1136/pgmj.2005.035311. PMC 1743408. PMID 16344301.
  3. ↑ 3.0 3.1 3.2 Ballantyne GH, Brandner MD, Beart RW, Ilstrup DM (1985). "Volvulus of the colon. Incidence and mortality". Ann. Surg. 202 (1): 83–92. PMC 1250842. PMID 4015215.
  4. ↑ 4.0 4.1 4.2 Halabi WJ, Jafari MD, Kang CY, Nguyen VQ, Carmichael JC, Mills S, Pigazzi A, Stamos MJ (2014). "Colonic volvulus in the United States: trends, outcomes, and predictors of mortality". Ann. Surg. 259 (2): 293–301. doi:10.1097/SLA.0b013e31828c88ac. PMID 23511842.
  5. ↑ 5.0 5.1 Wu MH, Chang YC, Wu CH, Kang SC, Kuan JT (2010). "Acute gastric volvulus: a rare but real surgical emergency". Am J Emerg Med. 28 (1): 118.e5–7. doi:10.1016/j.ajem.2009.04.031. PMID 20006232.
  6. ↑ Krupsky S, Halevy A, Orda R (1987). "Sigmoid volvulus in adolescence". J. Clin. Gastroenterol. 9 (4): 467–9. PMID 3655280.
  7. ↑ Burns, Cartland (2006). "Principles and Practices of Pediatric Surgery". Annals of Surgery. 243 (4): 567. doi:10.1097/01.sla.0000208423.52007.38. ISSN 0003-4932.
  8. ↑ Madiba TE, Aldous C, Haffajee MR (2015). "The morphology of the foetal sigmoid colon in the African population: a possible predisposition to sigmoid volvulus". Colorectal Dis. 17 (12): 1114–20. doi:10.1111/codi.13042. PMID 26112767.
  9. ↑ Michael SA, Rabi S (2015). "Morphology of Sigmoid Colon in South Indian Population: A Cadaveric Study". J Clin Diagn Res. 9 (8): AC04–7. doi:10.7860/JCDR/2015/13850.6364. PMC 4576524. PMID 26435933.
  10. ↑ Påhlman L, Enblad P, Rudberg C, Krog M (1989). "Volvulus of the colon. A review of 93 cases and current aspects of treatment". Acta Chir Scand. 155 (1): 53–6. PMID 2929205.
  11. ↑ Baker DM, Wardrop PJ, Burrell H, Hardcastle JD (1994). "The management of acute sigmoid volvulus in Nottingham". J R Coll Surg Edinb. 39 (5): 304–6. PMID 7861341.
  12. ↑ Isbister WH (1996). "Large bowel volvulus". Int J Colorectal Dis. 11 (2): 96–8. PMID 8739835.

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