Abstract
Aim Early diagnosis and evaluation of the severity of sigmoid volvulus are necessary for management and early intervention. We developed a new predictive classification system for sigmoid volvulus based on X-ray findings. Methods We retrospectively analyzed 66 patients diagnosed with sigmoid volvulus using the electronic medical records at the Osaki Citizen's Hospital and the University of Tokyo Hospital from 2008–2015. We classified patients according to the coffee-bean sign mesenteric axis on X-ray (AXIS classification: group A, 0–90°; group B, 90–135°; and group C, >135°). We examined the association between AXIS classification and severe sigmoid volvulus, intestinal necrosis, need for surgery, 30-day mortality, and length of stay using the Cochran–Armitage trend test. Results In total, 66 patients were analyzed. They had a mean age of 76.9 years, and 47 (71.0%) were male. They were classified into three groups according to the AXIS classification system (group A, 40 patients; group B, 23 patients; and group C, 3 patients). Group C had a significantly higher frequency of severe sigmoid volvulus (100%) compared to group B (30%) and group A (15%). AXIS classification was significantly associated with the severity of sigmoid volvulus (p = 0.003), necrosis (p = 0.004), and need for surgery (p = 0.001), but not with the 30-day mortality or the length of stay. Conclusions We developed the AXIS classification system to predict the severity of sigmoid volvulus. This new classification system may facilitate triage and therapeutic decision-making for sigmoid volvulus patients.
Highlights
Sigmoid volvulus is an obstructive bowel disease caused by abnormal twisting of the sigmoid colon and mesentery
We evaluated the association between the AXIS classification and severe sigmoid volvulus, intestinal necrosis, need for surgery, length of stay, and 30-day mortality using the Cochran–Armitage test for trend
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
Summary
Sigmoid volvulus is an obstructive bowel disease caused by abnormal twisting of the sigmoid colon and mesentery. The coffee-bean sign, an inverted U-shape between the twisting and distending of the sigmoid colon and mesenteric axis [3, 6], is an X-ray finding diagnostic of sigmoid volvulus. We developed a new predictive classification system based on abdominal X-ray indications of sigmoid volvulus (the AXIS classification system). Gastroenterology Research and Practice volvulus patients into three groups according to the direction of the axis of the coffee-bean sign.
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