Sigmoid Volvulus Patients Research Articles

Percutaneous endoscopic colostomy (PEC): an effective alternative in high risk patients with recurrent sigmoid volvulus.

Treatment of recurrent sigmoid volvulus is a major challenge in frail and elderly patients with multiple co-morbidities. Early management involves endoscopic decompression with high success rate, however, its recurrence make it a real challenge as most of these patients are not suitable for major colonic resection. The aim of this study was to assess the role of percutaneous endoscopic colostomy (PEC) in the treatment of recurrent sigmoid volvulus in these patients. Twelve PEC procedures were performed in 8 patients under our care. This prevented major colonic resection in 7 patients. One patient underwent sigmoid resection and died with postoperative complications. Two patients experienced minor complications. Three patients required repeat procedures for permanent PEC tube placement. Six patients managed permanently with PEC procedure. PEC is an effective treatment for recurrent sigmoid volvulus in high-risk elderly patients.

Sigmoid volvulus: is it a possible complication after stapled transanal rectal resection (STARR)?

We report a case of sigmoid volvulus post-stapled transanal rectal resection (STARR) for obstructed defecation. The patient, a 68-yearold woman with chronic constipation and dolichosigma, two days post-STARR presented severe abdominal pain. CT revealed sigmoid ischemia. The patient underwent resection of the sigmoid colon with end colostomy (Hartmann's procedure). Can STARR procedure produce a serious complication as sigmoid volvulus in patient with dolichosigma and obstructed defecation syndrome?

Stereological evaluation of ganglion cells in the sigmoid colon in primary and recurrent sigmoid volvulus

To clarify the role of ganglion cells in Auerbach’s plexus of the sigmoid colon in the development and recurrence of sigmoid volvulus (SV). Materials and methods: Pathological block samples of colonic resection materials of 28 patients who underwent sigmoidectomy for SV and, for comparison, samples of 28 patients who underwent sigmoidectomy or low anterior resection for rectosigmoid cancer (RSC) were analyzed using stereological methods. Results: The mean numerical density of ganglion cells was significantly lower in the SV group than in the RSC group (140.70 mm^{-2} and 669.42 mm^{-2}, respectively, P = 0.005), whereas there was no significant difference between the revolvulus and nonrevolvulus SV groups (128.45 mm^{-2} and 185.67 mm^{-2}, respectively, P > 0.05). Similarly, the mean numerical density of ganglion cells in elderly SV patients was found to be significantly lower than that in nonelderly SV patients (66.57 mm^{-2} and 214.86 mm-2, respectively, P = 0.002), while there was no significant difference between elderly and nonelderly RSC patients (638.60 mm^{-2} and 705.00 mm^{-2}, respectively, P > 0.05). Conclusion: SV may be related to a decreased numerical density of ganglion cells in Auerbach's plexus, and the degenerative loss of ganglion cells due to advancing age is possible in elderly SV patients.

Sigmoid volvulus in the elderly: Outcomes of a 43-year, 453-patient experience

The present study reviewed the clinical outcomes of 453 elderly patients with sigmoid volvulus (SV). The clinical records were reviewed retrospectively. The mean patient age was 71.1 years of age, and 371 patients (81.9%) were male. Of the patients, 30.7% had recurrent volvulus, 34.6% had associated disease, and 16.5% suffered from shock. The correct diagnosis rate based on the clinical features was 66.4%. Radiography revealed SV findings in 64.9% of the patients. Computed tomography (CT) or magnetic resonance imaging (MRI) were diagnostic in all cases. Nonoperative detorsion was performed in 323 patients (71.3%) with 77.4% success, 1.2% mortality, 4.0% morbidity, and 4.4% early recurrence rates. Emergency surgery was required in 215 patients (47.5%) and resulted in 24.2% mortality, 41.4% morbidity, 0.9% early recurrence, and 8.1% late recurrence rates. Elderly SV patients generally present with high percentages of recurrent volvulus, serious comorbidity, late admission, and shock. The clinical features may be less diagnostic. Radiological studies, particularly CT or MRI, may assist in an SV diagnosis. Nonoperative detorsion is advocated as the primary treatment. In emergency surgery, nonresectional or nonanastomotic procedures are preferred. The overall patient prognosis is grave, and the disease tends to recur.

Incisionless Hartmann’s procedure: an innovative minimal access technique for surgical treatment of sigmoid volvulus in debilitated patients with faecal incontinence

Sigmoid volvulus requires decompression and subsequent surgical correction, and is often seen in debilitated patients. In an effort to decrease the physiological burden of surgery in these high-risk patients, we report an innovative minimal access technique for the definitive treatment of decompressed sigmoid volvulus in patients with concomitant faecal incontinence. A retrospective chart review of a series of two consecutive patients who had undergone a minimal access Hartmann's procedure (HP) between November 2005 and October 2006 was performed. A single skin incision of < or = 4 cm at the proposed colostomy site was used to identify, exteriorize, divide, and resect the redundant mesosigmoid and sigmoid colon. The same incision was used to mature the end-colostomy. No other incisions were created, and no laparoscopy or laparoscopic instruments were used. Perioperative clinical parameters and outcomes are reported. Patient 1 was a 94-year-old male, American Society of Anesthesiologists (ASA) class 4, who underwent a HP via a 4-cm skin incision under general anaesthesia in 150 min with a length of inpatient stay of 5 days. Patient 2 was an 83-year-old female, ASA class 3, who underwent a HP via a 3-cm skin incision under conscious sedation in 83 min, with a length of inpatient stay of 4 days. Estimated blood loss was <50 cm(3) for both patients, both patients had bowel function and were tolerating oral feeds upon discharge, and there was no perioperative morbidity or mortality in either patient at 30 days. Incisionless HP appears feasible in treating sigmoid volvulus and faecal incontinence in debilitated patients.

Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly: A study of 33 cases

To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery. A retrospective review of the clinical presentation and imaging characteristics of 33 sigmoid volvulus patients was presented, as well as their diagnosis and treatment, in combination with a literature review. In 26 patients endoscopic detorsion was achieved after the first attempt and one patient died because of uncontrollable sepsis despite prompt operative treatment. Seven patients had unsuccessful endoscopic derotation and were operated on. On two patients with gangrenous sigmoid, Hartmann's procedure was performed. In five patients with viable colon, a sigmoid resection and primary anastomosis was carried out. Three patients had a lavage "on table" prior to anastomosis, while in the remaining 2 patients a diverting stoma was performed according to the procedure of the first author. Ten patients were operated on during their first hospital stay (3 to 8 d after the deflation). All patients had viable colon; 7 patients had a sigmoid resection and primary anastomosis, 2 patients had sigmoidopexy and one patient underwent a near-total colectomy. Two patients (sigmoidectomy-sigmoidopexy) had recurrences of volvulus 43 and 28 mo after the initial surgery. Among 15 patients who were discharged from the hospital after non-operative deflation, 3 patients were lost to follow-up. Of the remaining 12 patients, 5 had a recurrence of volvulus at a time in between 23 d and 14 mo. All the five patients had been operated on and in four a gangrenous sigmoid was found. Three patients died during the 30 d postoperative course. The remaining seven patients were admitted to our department for elective surgery. In these patients, 2 subtotal colectomies, 3 sigmoid resections and 2 sigmoidopexies were carried out. One patient with subtotal colectomy died. Taken together of the results, it is evident that after 17 elective operations we had only one death (5.9%), whereas after 15 emergency operations 6 patients died, which means a mortality rate of 40%. Although sigmoid volvulus causing intestinal obstruction is frequently successfully encountered by endoscopic decompression, however, the principal therapy of this condition is surgery. Only occasionally in patients with advanced age, lack of bowel symptoms and multiple co-morbidities might surgical repair not be considered.