Objective: To evaluate acute management of volvulus in Parkinson’s

Background: Constipation affects upto 50% of patients with Parkinson’s and sigmoid volvulus is an under recognized complication with mortality rates up to 50% (1).Management includes treating constipation, decompression and surgery.

Method: Parkinson’s patients admitted with volvulus in year 2021/2022 were identified by medical informatics. Data was collected from Electronic Patient Record.

Results: 10 (9 male) patients with average age of 75 years were reviewed. 4 had recurrent volvulus and all presented with abdominal pain and distention. Potassium levels and inflammatory markers (white cells and C reactive protein) were normal hence no antibiotics were used. Diagnosis was made with CT scan in all cases.

 1 patient had a double barrel colostomy, 9 had decompression with flatus tube insertion and flexible sigmoidoscopy and 1 recurrent presentation settled with enemas only.

Surgical Liaison team reviewed all patients, Rotigotine patch was used in all cases and switched back to usual Parkinson’s regimen on resolution.

Mortality rate of was 10 % reduced from 50%(3/6) seen in our Audit in 2016 on similar patient cohort. The average length of stay was 7.5 days.

Conclusion: Constipation and development of sigmoid volvulus is a complication of Parkinson’s. 90% cases did not require surgical intervention. All patients received in put for surgical liaison team and Parkinson’s medications were optimised reducing risk of complications including death in comparison to previous audit. This highlights the importance of geriatrician led perioperative service. The rate of recurrence (40%) and length of hospital stay were high suggesting significant burden on patients and health care service.

References: https://doi.org/10.4997/jrcpe.2016.303

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MDS Abstracts - https://www.mdsabstracts.org/abstract/management-of-sigmoid-volvulus-in-parkinsons-patients-presenting-to-royal-berkshire-hospital-reading-uk/