Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Dec 28;20(48):18384-9.
doi: 10.3748/wjg.v20.i48.18384.

More patients should undergo surgery after sigmoid volvulus

Anne Kathrine Wewer Ifversen  1 , Daniel Willy Kjaer  1
Affiliations
Comparative Study

More patients should undergo surgery after sigmoid volvulus

Anne Kathrine Wewer Ifversen et al. World J Gastroenterol. .

Abstract

Aim: To assess the outcome of patients treated conservatively vs surgically during their first admission for sigmoid volvulus.

Methods: We conducted a retrospective study of 61 patients admitted to Aarhus University Hospital in Denmark between 1996 and 2011 for their first incidence of sigmoid volvulus. The condition was diagnosed by radiography, sigmoidoscopy or surgery. Patients treated with surgery underwent either a sigmoid resection or a percutaneous endoscopic colostomy (PEC). Conservatively treated patients were managed without surgery. Data was recorded into a Microsoft Access database and calculations were performed with Microsoft Excel. Kaplan-Meier plotting and Mantel-Cox (log-rank) testing were performed using GraphPad Prism software. Mortality was defined as death within 30 d after intervention or surgery.

Results: Among the total 61 patients, 4 underwent emergency surgery, 55 underwent endoscopy, 1 experienced resolution of the volvulus after contrast enema, and 1 died without treatment because of large bowel perforation. Following emergency treatment, 28 patients underwent sigmoid resection (semi-elective n = 18; elective n = 10). Two patients who were unfit for surgery underwent PEC and both died, 1 after 36 d and the other after 9 mo, respectively. The remaining 26 patients were managed conservatively without sigmoid resection. Patients treated conservatively on their first admission had a poorer survival rate than patients treated surgically on their first admission (95%CI: 3.67-14.37, P = 0.036). Sixty-three percent of the 26 conservatively treated patients had not experienced a recurrence 3 mo after treatment, but that number dropped to 24% 2 years after treatment. Eight of the 14 patients with recurrence after conservative treatment had surgery with no 30-d mortality.

Conclusion: Surgically-treated sigmoid volvulus patients had a higher long-term survival rate than conservatively managed patients, indicating a benefit of surgical resection or PEC insertion if feasible.

Keywords: Percutaneous endoscopic colostomy; Recurrence; Resection; Sigmoid volvulus; Surgery.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flowchart of treatment for patients with sigmoid volvulus.
Figure 2
Figure 2
Recurrence-free time for patients without surgery.
Figure 3
Figure 3
Survival after surgery or conservative treatment.
See this image and copyright information in PMC

References

    1. Kabara JJ, Riggin RM, Kissinger PT. Abnormal levels of urinary catecholamines in dystrophic mice and hamsters. Proc Soc Exp Biol Med. 1976;151:168–172. - PubMed
    1. Peña AS, Lems-van Kan PH, Kuiper I, van Duijn W, Lamers CB. Measurement of mucosa-specific antibodies against gliadin by a sensitive technique using the biotin-streptavidin system. Acta Gastroenterol Belg. 1986;49:423–426. - PubMed
    1. Bruusgaard C. Volvulus of the sigmoid colon and its treatment. Surgery. 1947;22:466–478. - PubMed
    1. Grigg MM, Costanzo-Nordin MR, Celesia GG, Kelly MA, Silver MA, Sobotka PA, Robinson JA. The etiology of seizures after cardiac transplantation. Transplant Proc. 1988;20:937–944. - PubMed
    1. Bhatnagar BN, Sharma CL, Gupta SN, Mathur MM, Reddy DC. Study on the anatomical dimensions of the human sigmoid colon. Clin Anat. 2004;17:236–243. - PubMed

Publication types

MeSH terms