The Outcome Of Sigmoid Volvulus Cases: A Single Centre Experiences Over 8 Years

Abstract

Introduction
 Sigmoid volvulus is one of the causes of large bowel obstruction. Its management can be challenging because of its prevalence in high-risk individuals. This study was designed to review the management and outcome of all patients admitted with sigmoid volvulus.
 Methods
 A retrospective review of all patients admitted at Hospital Sultanah Nur Zahirah, Terengganu, for Sigmoid Volvulus from January 2015 to December 2022 was performed. The data was extracted from Hospital Information System (HIS) and analysed using SPSS 27.
 Results
 Twenty-four patients were admitted, a total of 41 admissions for sigmoid volvulus during the study periods. The majority of the patients (n=16, 66.7%) were male and (n=8,33.3%) were female. Seven (29.2%) patients underwent emergency surgery on the presentation, and three (12.5%) patients died on admission due to septic shock. The remaining 14 (58.3%) were managed by endoscopic decompression. 13 (92.9%) patients had successful decompression procedures, and one patient (7.1%) failed, which required emergency surgery. About seven patients (53.8%) were readmitted for recurrence of sigmoid volvulus after successful decompression on initial admission, in which subsequently all of them required emergency surgery. The remaining six (46.2%) did not experience any recurrence episodes, and three (50%) of them underwent subsequent elective surgery. In our series, three patients died on initial presentation due to perforation and septic shock without any intervention, two patients died after emergency surgery due to septic shock and multi-organ failure, and one patient died due to covid 19 pneumonia. There was no mortality after elective surgery.
 Conclusion
 Sigmoid volvulus is a surgical emergency in which the majority (58.3%) can be successfully decompressed non-operatively. Emergency surgery in these patients is associated with 13.3% mortality in our series. Elective definitive surgery is suggested in view of the high recurrence rate (>50%) and considerable risk of emergency surgery.