Clinical outcomes of sigmoid colon volvulus: identification of the factors associated with successful endoscopic detorsion

BACKGROUND/AIMS: Although multiple treatment options exist for the management of sigmoid colon volvulus, no study has examined the factors associated with successful endoscopic detorsion. This study aimed to examine the clinical course of patients with sigmoid colon volvulus and to identify factors related to successful endoscopic detorsion. METHODS: This study included 30 cases (21 patients) of sigmoid volvulus from among 545 cases of intestinal obstruction at a single center. We retrospectively examined the clinical course and the factors associated with the possibility of endoscopic detorsion of sigmoid colon volvulus. RESULTS: The rate of laxative use among the study participants was 76.2%; the rate of comorbid neuropsychiatric disorders was 61.9%; and 57.1% of patients had a history of open abdominal surgery. All patients were initially treated with endoscopic detorsion, and this procedure had a 61.9% success rate. The recurrence rate after detorsion was as high as 46.2%, but detorsion during revision endoscopy was possible in all cases. Statistical analysis revealed that the absence of abdominal tenderness (P=0.027), the use of laxatives (P=0.027), and a history of open abdominal surgery (P=0.032) were factors predictive of successful endoscopic detorsion. CONCLUSIONS: The results of our study are consistent with previous reports with respect to the success rate of endoscopic detorsion, the subsequent recurrence rate, and the proportion of patients requiring surgical treatment. In addition, we identified the absence of abdominal tenderness, the use of laxatives, and history of open abdominal surgery as factors predicting successful endoscopic detorsion of sigmoid colon volvulus.

A clinical study of palliative treatment for cancer pain and uncontrolled symptoms in patients with recurrent gastric cancer / 日本農村医学会雑誌

We investigated the current status and problems of cancer pain relief, sedation for cancer pain and uncontrolled symptoms in patients with recurrent gastric cancer. The subjects of this study were 59 patients with recurrent gastric cancer undergoing palliative treatment in the Department of Surgery of our hospital. We retrospectively examined the modality of cancer pain relief, use of sedation and the reason for sedation. Outpatient treatment lasted 0-682 days (mean ; 195.3 days) and hospitalization 1-117 days(mean ; 32.1 days). Nonsteroidal antiinflammatory drugs were used for all patients. Morphine was administered to 50 patients (84.7%). Analgesic effects were seen in all patients. No servere adverse events occurred. Sedation was used in 33 (55.9%) for general fatigue (28) and/or restlessness (17). We concluded that analgesia was sufficient and safe with nonsteroidal antiphlogistic and pharmaceutical morphines, but about half of the cases required sedation.