Abstract
BackgroundAcute sigmoid volvulus (ASV) represents a small but significant portion of cases of large bowel obstruction, especially in the elderly and co-morbid. Given the characteristics of the patient cohort most commonly affected, a non-operative/conservative approach is often undertaken but is associated with a high rate of recurrence.ObjectiveWe sought to evaluate outcomes for those patients who underwent non-operative management, emergency surgery or staged, semi-elective surgery following decompression for ASV at our institution.MethodsHospital in-patient enquiry (HIPE) data were used to identify all patients who presented with sigmoid volvulus between January 2005 and June 2020 inclusive. Patient notes were interrogated, including surgical and endoscopic procedures performed. Patient demographics and co-morbidities were recorded.ResultsThirty-nine patients were treated over a 15-year period with a mean age of 73 years at first presentation (range 36–93). Twenty-two patients (56%) had just a single admission for ASV with three deaths in this group.Seventeen patients (44%) had more than one admission with volvulus due to recurrence after a decompression-only strategy on the index admission. Of these, three succumbed to complications of their subsequent episodes of volvulus.Twenty-five patients underwent surgical intervention (fifteen on, or shortly following, their first admission and ten following at least two admissions for ASV). The overall mortality in the operative group was 2/25 (8%) with both deaths in those undergoing emergency surgeries. Five patients were treated successfully with endoscopic measures alone and had required no further interventions at the time of compiling data.ConclusionThere is a high recurrence rate following non-operative management of acute sigmoid volvulus and consequently, a cumulative increase in the attendant significant morbidity and mortality with subsequent episodes. Given the relatively low complication rate of definitive surgery, even in those patients perceived to be high risk, we contend that all patients should be considered for early surgery to prevent the likely recurrence of sigmoid volvulus.
Highlights
Acute sigmoid volvulus occurs when a long or redundant segment of the sigmoid colon twists upon its own mesentery resulting in colonic obstruction and, if uncorrected, eventually bowel ischaemia [1, 2]
Elective surgery was defined as planned surgery following successful endoscopic decompression or surgery at a later, separate, admission
Thirty-nine patients were treated for sigmoid volvulus over a 15.5-year period January 2005–June 2020 inclusive
Summary
Acute sigmoid volvulus occurs when a long or redundant segment of the sigmoid colon twists upon its own mesentery resulting in colonic obstruction and, if uncorrected, eventually bowel ischaemia [1, 2] It is most predominant in Indian, African and Middle Eastern countries, it is seen worldwide with a predilection for the elderly and infirm. Conclusion There is a high recurrence rate following non-operative management of acute sigmoid volvulus and a cumulative increase in the attendant significant morbidity and mortality with subsequent episodes. Given the relatively low complication rate of definitive surgery, even in those patients perceived to be high risk, we contend that all patients should be considered for early surgery to prevent the likely recurrence of sigmoid volvulus
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