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. 2022 Feb;104(2):95-99.
doi: 10.1308/rcsann.2021.0123. Epub 2021 Dec 3.

Dilemma of sigmoid volvulus management

A Abdelrahim  1 , S Zeidan  1 , M Qulaghassi  1 , O Ali  1 , M Boshnaq  1   2
Affiliations

Dilemma of sigmoid volvulus management

A Abdelrahim et al. Ann R Coll Surg Engl. 2022 Feb.

Abstract

Introduction: Patients with sigmoid volvulus (SV) are at a high risk of recurrence with increased morbidity and mortality. This study aims to review whether patients with SV underwent definitive surgical treatment after initial endoscopic reduction according to the guidelines, and to compare mortality rate between surgical and conservative management.

Methods: Retrospective study conducted at East Kent Hospitals University NHS Foundation Trust, included all patients with SV between 2016 and 2018. The primary outcome was 30-day mortality following the initial management of the acute attack. Secondary outcomes were recurrence rate and overall mortality. The median follow-up period was 3 years.

Results: A total of 40 patients were identified with a median age of 82 years; 27 (67%) were males. Of these 40 patients, 6 (15%) had emergency surgery, 26 (65%) received endoscopic decompression only, and 8 (20%) had planned definitive resection; 32 patients (80%) had recurrence and the median interval between any two episodes was 86 days. The mortality rate among patients with ASA grade 3 or 4 in the three groups, elective surgery, emergency surgery and decompression only, was 0%, 25% and 70% respectively, whereas it was 0%, 50% and 33% in those with ASA grade 2. The mortality rate among patients with similar ASA who had a planned surgery was significantly lower compared with those who did not undergo surgery (p=0.003).

Conclusions: In patients with sigmoid volvulus, regardless of ASA grade, performing early definitive surgery following initial endoscopic decompression resulted in a statistically significant lower mortality rate.

Keywords: Interstinal obstruction; Large bowel obstruction; Sigmoid volvulus.

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Figures

Figure 1
Figure 1
Initial management of index admission and further progression following conservative management
Figure 2
Figure 2
Recurrence rate and further progress following recurrence
Figure 3
Figure 3
Assessment of fitness and further management
See this image and copyright information in PMC

References

    1. Naveed M, Jamil LH, Fujii-Lau LLet al. . American society for gastrointestinal endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus. Gastrointest Endosc 2020; 91: 228–235.10.1016/j.gie.2019.09.007 - DOI - PubMed
    1. Gingold D, Murrell Z. Management of colonic volvulus. Clin Colon Rectal Surg 2012; 25: 236–244.10.1055/s-0032-1329535 - DOI - PMC - PubMed
    1. Hinshaw DB, Carter R. Surgical management of acute volvulus of the sigmoid colon; a study of 55 cases. Ann Surg 1957; 146: 52–60.10.1097/00000658-195707000-00006 - DOI - PMC - PubMed
    1. Dahlberg M, Hallqvist Everhov Å. Entrapment is an essential feature of sigmoid volvulus. ANZ J Surg 2020; 90: 1540–1541.10.1111/ans.15758 - DOI - PubMed
    1. Ishibashi R, Niikura R, Obana Net al. . Prediction of the clinical outcomes of sigmoid volvulus by abdominal x-ray: AXIS classification system. Gastroenterol Res Pract 2018; 2018: 1–5.10.1155/2018/8493235 - DOI - PMC - PubMed