Gangrene of Large Bowel due to Volvulus- Etiopathogenesis, Management and Outcome

Large bowel volvulus accounts for 10-30% of all large bowel obstruction and occurs most commonly in the sigmoid colon(Asbun 1992, Bagarani 1993, Bhatnagar 2004, Oren 2007, Pahlman 1989 ). It is more common in the region of Africa, South America, Middle East and Southern Asia. The most common site of volvulus include sigmoid colon(80%), caecum(15%), transverse colon(3%), splenic flexure(2%) and ileosigmoid knotting(<1%)( Bhatnagar 2004, Oren 2007, Halliday 1993, Majeski 2005, Lord 1996). Delay in presentation and diagnosis increases the risk of gangrene particularly so among the uncommon variety because of its atypical presentation and sometimes quite scarce manifestations(Bhatnagar 2004, Halliday 1993, Majeski 2005,Lord 1996). The outcome depends on intensive and adequate resuscitation with fluids and broad spectrum antibiotics and prompt resection of the gangrenous loop of gut(Asbun 1992, Bagarani 1993, Bhatnagar 2004, Halliday 1993, Majeski 2005,Lord 1996). The mortality rate even though has improved significantly in recent years due to better perioperative management of these patients, continues to remain high when gangrene sets in. The various factors that influence the outcome include general factors like advanced age of the patient, associated comorbid conditions and local factors including perforation , peritonitis and presence of shock(Bhatnagar 2004, Halliday 1993, Majeski 2005,Lord 1996, Halliday KE 1993, Feldman D 2000). This chapter intends to discuss the etiopathogenesis, presentation, investigation and management of both common and uncommon volvulus of the colon with emphasis on those volvulus being complicated with gangrene