Surgery to treat volvulus of the colon

This article is professionally consulted by resident Doctor Le Thanh Tuan - Department of General Surgery - Vinmec Nha Trang International Hospital. The doctor has extensive experience in examination, treatment and surgery of abdominal diseases.

The midgut is the term used to refer to the part of the digestive tract from the ampulla of Vater to the middle part of the transverse colon in the fetus. During fetal development, the mesocolon will rotate around the axis of the superior mesenteric artery, fixate on the abdominal wall to form the duodenum below the ampulla of Vater, the small intestine, the cecum, the ascending colon, and the lateral transverse half of the colon. right.
Mesenteric volvulus is a congenital anomaly in which the bowel rotates and is incompletely fixed during fetal development. The entire small intestine and part of the colon are fixed to the abdominal wall only by a narrow mesentery, which makes the midgut susceptible to torsion. Colonic volvulus occurs in 0.5-1% of the population, mainly in neonates. The clinical presentation ranges from asymptomatic to volvulus. If the bowel is malrotated and there is no volvulus, the patient has no real symptoms. If the malrotated bowel has volvulus, there are symptoms. The rate of having symptoms is 1 in 6,000. Mesenteric volvulus is often accompanied by pathologies such as acute or chronic duodenal obstruction, congenital diaphragmatic hernia, abdominal wall cleft, Meckel's diverticulum, and biliary tract abnormalities.

Colic volvulus is rare but is a very serious disease, if not detected and intervened in time, the entire small intestine and part of the young colon can be necrotic. Common symptoms when children with volvulus are:
Poor suckling, often vomiting a lot of yellow-green fluid Dehydration, malnutrition, severe electrolyte disturbances Tachycardia, rapid breathing, breathing If the circulatory volume is lost, small bowel ischemia develops, the child may experience septic shock with manifestations such as hypotension, respiratory failure, melena, vomiting blood, metabolic acidosis, leukopenia platelets, platelets,...

Children who are diagnosed with volvulus need to be operated quickly, except in the case of coagulopathy. There are two types of volvulus surgery: open surgery and laparoscopic surgery. Before surgery, the child will be rehydrated, electrolytes, gastric suction tube inserted, prophylactic antibiotics, enough tests to evaluate the general condition.
2.1 Surgery to treat volvulus by open surgery The child lies on the operating table, the surgeon stands on the right, the assistant stands on the left side of the child. After anesthesia, the doctor made a transverse skin incision under the right lower quadrant. The surgical stages include:
Detorsion Ladd ligamentectomy, duodenal release, common mesenteric load extension Appendectomy Left cecum and fixation to abdominal wall 2.2 Laparoscopic surgery to treat volvulus of the midgut Child lying on operating table, the surgeon stands at the child's feet, the assistant holding the camera stands to the right of the surgeon. The monitor is placed on the opposite side of the surgeon. Place 3 trocars into the abdomen at the positions of the navel, right lower quadrant, and left lower quadrant. Inflatable pressure is maintained from 7-9 mmHg with a flow rate of 2-3 l/min depending on age. The surgical phases are similar to the open surgery method. The laparoscopic surgery method is less invasive, the child recovers quickly, the scars are small and heals quickly, the rate of complications is low. However, in order to perform laparoscopic surgery, it is necessary to have modern equipment, highly qualified and trained surgeons in laparoscopic surgery.

Children after surgery need to maintain body temperature by incubator, balance water and electrolytes if necessary. Use antibiotics to fight infections.
Feed the child by parenteral nutrition for the first 3 days. Perform intermittent suction of gastric juice, until there is no bile, the baby can be breastfed with an increasing amount. If there is a nasogastric tube placed through the anastomosis, pump milk through the catheter from the 3rd day after surgery for early feeding.
Closely monitor the child's condition, if there is a complication of intestinal obstruction or volvulus, repeat surgery.

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