Management of acute volvulus of the sigmoid colon: a new approach by percutaneous deflation and colopexy

Abstract

Forty-one consecutive patients with acute sigmoid volvulus were prospectively randomized into 2 groups to compare percutaneous deflation prior to emergency tube decompression followed electively by colopexy with banding (n = 20) versus emergency tube decompression followed electively by sigmoid colectomy (n = 21). Of 21 patients subjected to tube decompression, the procedure was successful in 15 (71%). Emergency sigmoid colectomy was done in the remaining 6 patients and 3 of them died postoperatively. Percutaneous deflation enabled all patients (n = 20) to have successful tube decompression without complications. Two of the patients (13%) who underwent elective sigmoid colectomy died postoperatively and another 2 developed wound infections, whereas colopexy by banding caused no mortality and only 1 patient (5%) developed a wound infection. Disconnection of the intravenous line, consumption of solid food, and discharge from the hospital were each effected at significantly (p less than 0.001) earlier postoperative times with colopexy than with sigmoid colectomy. Both of these elective procedures were equally effective in preventing recurrence of the volvulus. During 1 year of follow-up, colopexy was not observed to cause any abdominal pain or alteration in bowel habits. This study shows that percutaneous deflation of acute sigmoid volvulus is a rapid and safe method which enables successful sigmoidoscopic decompression with avoidance of emergency surgery and its high mortality rates. The study also shows that colopexy by banding is a simple elective procedure which overcomes the limitations of mesenteropexy and resectional surgery.