The procedure involves counterclockwise
detorsion of the bowel, surgical division of Ladd's bands, widening of the small intestine's mesentery, appendectomy and placement of the intestines to the right of the abdomen and the colon to the left [2].
Given that endoscopic
detorsion will likely be unsuccessful due to the double-loop knot and is hazardous given the possibility of missing ileal gangrene, endoscopic decompression is generally not attempted in ISK.
Detorsion (reperfusion) was performed after a 3-hour torsion period.
In addition to diagnostic evaluations, colonoscopy enables therapeutic procedures such as biopsy, polypectomy, endoscopic mucosal resection, volvulus
detorsion, bleeding control, dilatation of strictures, and endoluminal stent applications (6).
Of the 66 patients, 1 patient was treated with rehydration therapy; 51 patients underwent only endoscopic interventions, such as flexible endoscopic
detorsion or endoscopic placement of a sliding tube; 5 patients underwent endoscopic
detorsion and subsequent sigmoidectomy; and 9 patients received a sigmoidectomy without endoscopic interventions.
Past surgical history was
detorsion of the right ovary and oophoropexy in retrouterine position 4 months earlier.
The American Society of Colon and Rectal Surgeons suggest initial rigid or flexible endoscopy to assess for intestinal viability and to effect therapeutic
detorsion and decompression (Grade 1c) [11]; this is reported to be successful in 75-95% of cases [11-13].
Laparoscopic
detorsion of isolated idiopathic Fallopian tuve torsion: conservative treatment in a 13-year-old girl.
In the past, salpingo-oophorectomy without prior
detorsion was the traditional mode of treatment, due to the fear of thromboembolism.
The sigmoid colon was decompressed after
detorsion (Figure 3).
In case 2, uterus has developed thick adhesions with surrounding peritoneum and viscera that made
detorsion impossible.
If
detorsion is not performed within a suitable time frame, the testis undergoes necrosis (2).
