Volvulus epidemiology and demographics: Difference between revisions
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==Overview== | ==Overview== | ||
Acute mechanical small bowel obstruction is a common surgical emergency [1,2,6]. It is estimated that over 300,000 laparotomies per year are performed in the United States for adhesion-related obstructions [7,8]. Ischemia, which complicates 7 to 42 percent of bowel obstructions, significantly increases mortality associated with bowel obstruction [5]. | |||
The small bowel is involved in approximately 80 percent of cases of mechanical intestinal obstruction [9,10]. The incidence is similar for males and females. In one study of adult patients, the average age of patients with acute obstruction was 64 years, women comprised 60 percent of the group, and the small bowel was affected in 76 percent [9]. | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
===Incidence=== | |||
*The incidence of volvulus is approximately 2 per 100,000 individuals worldwide. | |||
*Sigmoid volvulus has the highest incidence accounting for 75 - 80% of volvulus cases | |||
*Cecal volvulus has the second highest incidence accounting for 20 - 25% of volvulus cases. | |||
*In other studies, the incidence of cecal volvulus ranged from 2.8 to 7.1 per million people per year [4,6].. | |||
*Gastric volvulus is rare. | |||
===Prevalence=== | |||
In an epidemiologic study, 63,749 cases of colonic obstruction were admitted in the United States from 2002 to 2010 [14]. The incidence of cecal volvulus increased by 5.53 percent per year, whereas the incidence of sigmoid volvulus remained stable. | |||
*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=== | |||
*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 case-fatality rate/mortality rate of [disease name] is approximately [number range]. | |||
===Age=== | |||
Sigmoid volvulus usually occurs in older adults with a mean age of 70 years at presentation [5]. | |||
Sigmoid volvulus has been reported in younger patients and in children in association with abnormal colonic motility [15-20]. (See 'Colonic dysmotility' below.) | |||
astric volvulus is rare. The incidence peaks after the fifth decade with adults constituting 80 to 90 percent of cases | |||
*Patients of all age groups may develop [disease name]. | |||
*The incidence of [disease name] increases with age; the median age at diagnosis is [#] years. | |||
*[Disease name] commonly affects individuals younger than/older than [number of years] years of age. | |||
*[Chronic disease name] is usually first diagnosed among [age group]. | |||
*[Acute disease name] commonly affects [age group]. | |||
===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]. | |||
*There is no racial predilection to [disease name]. | |||
*[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name]. | |||
===Gender=== | |||
==Gastric Volvulus== | |||
G[5]. No association with sex or race has been reported. | |||
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=== | |||
*The majority of [disease name] cases are reported in [geographical region]. | |||
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".) | |||
*[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== | ||
Revision as of 18:10, 27 December 2017
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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 [1,2,6]. It is estimated that over 300,000 laparotomies per year are performed in the United States for adhesion-related obstructions [7,8]. Ischemia, which complicates 7 to 42 percent of bowel obstructions, significantly increases mortality associated with bowel obstruction [5].
The small bowel is involved in approximately 80 percent of cases of mechanical intestinal obstruction [9,10]. The incidence is similar for males and females. In one study of adult patients, the average age of patients with acute obstruction was 64 years, women comprised 60 percent of the group, and the small bowel was affected in 76 percent [9].
Epidemiology and Demographics
Incidence
- The incidence of volvulus is approximately 2 per 100,000 individuals worldwide.
- Sigmoid volvulus has the highest incidence accounting for 75 - 80% of volvulus cases
- Cecal volvulus has the second highest incidence accounting for 20 - 25% of volvulus cases.
- In other studies, the incidence of cecal volvulus ranged from 2.8 to 7.1 per million people per year [4,6]..
- Gastric volvulus is rare.
Prevalence
In an epidemiologic study, 63,749 cases of colonic obstruction were admitted in the United States from 2002 to 2010 [14]. The incidence of cecal volvulus increased by 5.53 percent per year, whereas the incidence of sigmoid volvulus remained stable.
- 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
- 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 case-fatality rate/mortality rate of [disease name] is approximately [number range].
Age
Sigmoid volvulus usually occurs in older adults with a mean age of 70 years at presentation [5]. Sigmoid volvulus has been reported in younger patients and in children in association with abnormal colonic motility [15-20]. (See 'Colonic dysmotility' below.) astric volvulus is rare. The incidence peaks after the fifth decade with adults constituting 80 to 90 percent of cases
- Patients of all age groups may develop [disease name].
- The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
- [Disease name] commonly affects individuals younger than/older than [number of years] years of age.
- [Chronic disease name] is usually first diagnosed among [age group].
- [Acute disease name] commonly affects [age group].
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].
- There is no racial predilection to [disease name].
- [Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
Gender
Gastric Volvulus
G[5]. No association with sex or race has been reported.
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
- The majority of [disease name] cases are reported in [geographical region].
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".)
- [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]