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[다양한 대장 질환 043]

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전형적인 sigmoid volvulus입니다. 내시경 감압술을 몇 번 시행하였습니다. 내시경 감압술 직후에는 증상도 좋아지고 사진에서 공기가 거의 다 빠진 양상이었지만 얼마 후 다시 처음과 비슷한 상태가 되었습니다. 결국 laparoscopic sigmoidectomy를 시행하였습니다. 이런 경과는 매우 흔합니다. 내시경 감압술 후 완전히 volvulus가 풀리는 경우는 많지 않았던 것 같습니다. 반반이라고나 할까요. 혹은 그 이하.

* 참고: Management of Sigmoid Volvulus Avoiding Sigmoid Resection Case Rep Gastroenterol 2012

Acute sigmoid volvulus is typically caused by an excessively mobile and redundant segment of colon with a stretched mesenteric pedicle. When this segment twists on its pedicle, the result can be obstruction, ischemia and perforation... Although urgent resective surgery seems to be the appropriate treatment for those who present with acute abdominal pain, intestinal perforation or ischemic necrosis of the intestinal mucosa, the first therapeutic choice for clinically stable patients in good general condition is considered, by many institutions, to be endoscopic decompression. Controversy exists on the decision of the time, the type of definitive treatment, the strategy and the most appropriate surgical technique, especially for teenagers for whom sigmoid resection can be avoided.

The gold standard procedure for a clinically stable patient is decompressive colonoscopy, as long as no signs of peritonitis secondary to ischemia or colon perforation exist, with a rate of effectiveness ranging from 70 - 90% and a recurrence rate of 18 - 90%. If the colonoscopy is not effective or if the patient develops signs of peritonitis, urgent surgery is indicated.

[More cases]

Sigmoid volvulus였습니다. Endoscopic volvulus reduction 후 증상 재발하여 laparoscopic sigmoidectomy 시행하였습니다.

Sigmoid volvulus였으나 증상이 심하고 ischemia 소견이 현저해 즉시 수술하였습니다.


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© 일원내시경교실 바른내시경연구소 이준행. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.