Sigmoid Volvulus Research Articles

Sigmoid volvulus and descending colon adenocarcinoma, a double cause of intestinal obstruction: a case report

Sigmoid volvulus and descending colon adenocarcinoma, a double cause of intestinal obstruction: a case report

068. Revealing the Hidden Giant: When Giant Appendicitis Mimics A Mesenteric Cyst in Recurrent Sigmoid Volvulus – A Case Report

Background: Giant appendicitis is an exceptionally rare condition that can mimic other intra-abdominal pathologies, including mesenteric cysts, due to its unusual size and presentation. Distinguishing between these entities is chalenging due to its resemblances. Case: A 56-year-old woman with a history of chronic constipation who was admitted to the emergency department with abdominal distension and inability to defecate. Abdominal examination revealed a distended abdomen with visible bowel contour and an abdominal X-ray showed coffee bean appearance, suggestive of sigmoid volvulus. An exploratory laparotomy revealed twisting of the sigmoid colon. After reducing the volvulus and confirming viability of the sigmoid, a loop sigmoidostomy was performed to prevent recurrent volvulus. Intraoperatively, a mass resembling a mesenteric cyst was identified, which was subsequently confirmed to be a case of giant appendicitis. Conclusion: Considering giant appendicitis in the differential diagnosis of abdominal masses resembling mesenteric cysts is important, particularly in patients with chronic constipation and recurrent volvulus, to ensure timely and appropriate surgical management.

A Rare Case Report Of Sigmoid Volvulus – An Important Differential To Consider In Acute Abdomen

Background: Sigmoid volvulus an uncommon source of bowel obstruction in middle-aged individuals.. This perilous condition pervades globally, with a pronounced predilection for elderly population burdened by concurrent health ailments. While both genders can fall victim, males (1) are more frequently affected. Case Report: A middle aged gentleman presented to emergency center reporting pain abdomen, vomiting , obstipation. On palpation generalized tenderness , guarding present, X – ray abdomen showed classic coffee bean (volvulus) immediately underwent emergency laparotomy - found sigmoid colon was distended and gangrenous. Sigmoidectomy with Hartmann’s performed. Conclusion: This case underscores the criticality of swift action in addressing this life-threatening ailment. Its evaluation should be of utmost importance among the potential diagnoses for individuals reporting with abdominal distention and pain, vomiting,obstipation. An abdominal X-ray (3) both erect and supine positions provides excellent diagnostic results

Transanal Decompression Tube Placement for Treatment of Sigmoid Volvulus.

This study was performed to investigate the efficacy of nonoperative treatment of uncomplicated sigmoid volvulus (SV) using a transanal decompression tube (TDT). This was a single-center retrospective study in patients with SV treated between 2008 and 2021. For uncomplicated patients, nonoperative decompression of any of four types was performed: decompression with a colonoscope (CS), TDT without CS, TDT with CS (tip in the sigmoid colon), and TDT with CS (tip in the descending colon). A total of 72 patients with 109 admissions were enrolled in the study. Of these, 69 patients with uncomplicated SV were initially managed nonoperatively, whereas no procedures were performed in three patients due to presentation with septic shock on arrival. Of the 69 patients, 11 underwent surgery and two refused surgical management. Three patients showed improved CS without TDT. Among 53 patients who improved nonoperatively with TDT, 14 (26.4%) experienced recurrence with a median (range) time to recurrence of 603 (43-2714) days. No early recurrence was observed. Of a total of 106 cases with decompression, 97 (91.5%) were performed with TDT and all were completed without complications. The median (range) duration of decompression using TDT in these 81 cases without surgery was 5 (2-11) days. In the Cox proportional hazards regression model, only previous history of SV was associated with recurrence (hazard ratio 3.60; 95% confidence interval 1.24-10.46, p = 0.02). Decompression using TDT is safe, effective, and may reduce the rate of recurrence in patients with uncomplicated SV.

A Rare Case Report of the Successful Management of Perforated Sigmoid Volvulus in a Pregnant Woman With Massive Pneumoperitoneum: First Case in Yemen

A Rare Case Report of the Successful Management of Perforated Sigmoid Volvulus in a Pregnant Woman With Massive Pneumoperitoneum: First Case in Yemen

Treatment Strategies for Sigmoid Volvulus : A case series of 15 patients

Sigmoid volvulus, a condition characterized by the twisting of the sigmoid colon, is a frequent cause of large bowel obstruction. This study aims to review and evaluate the treatment strategies applied to 15 patients diagnosed with sigmoid volvulus at our institution. The outcomes, complications, and long-term results were analyzed to identify the most effective management approaches. The treatment modalities ranged from conservative management to surgical interventions. Our findings indicate that a multidisciplinary approach, timely intervention, and appropriate patient selection are key determinants of successful outcomes.

S3611 A Collaborative Endoscopic-Surgical Approach to Sigmoid Volvulus Caused by Peritoneal Metastases

S3611 A Collaborative Endoscopic-Surgical Approach to Sigmoid Volvulus Caused by Peritoneal Metastases

Delayed Diagnosis of Volvulus without Complications in Pediatric Patient : A Case Report

Introduction: Volvulus in children is rare occurrence, it’s only about 3-5% cases in worldwide. Without abdominal radiological examination, it is difficult to make diagnosis of volvulus based on history and physical examination alone. The management procedures are also controversial, as some recommend a non-operative approach, while others recommend an operative approach in the form of Ladd's Procedure or laparoscopy. Sigmoidoscopy or a barium enema can be attempted as an initial treatment for sigmoid volvulus. Objective: The purpose of this case report is to discuss why there was a delay in diagnosis of volvulus in this case and how to deal it. It also discusses the approach to diagnosis and management of volvulus in pediatric patients, both at the primary health center and the hospital, and why in this case. Case presentation: In this case, volvulus occurred in a pediatric patient who had sought treatment at a primary health center with a complaint of abdominal pain for nine days without improvement. The complaint was accompanied with constipation and fever. Due to limited facilities in primary health center, the patient was referred to the hospital. Result: At the hospital, after taking the history, performing physical examination, and conducting radiological examination and laboratory tests, the patient was diagnosed with ileus obstruction due to volvulus. Conclusion: Although volvulus is a rare case, volvulus should still be included as a differential diagnosis of abdominal pain in pediatric patients to avoid delayed diagnosis. Delay in diagnosis and management of volvulus can lead to serious complications and even life-threatening conditions

Comparison of the ability of resection versus nonresection surgery to prevent the recurrence of sigmoid volvulus: A protocol of a meta-analysis and systematic review.

Based on clinical research guidelines and clinical practice, patients with sigmoid volvulus (SV) who receive conservative treatment have a greater recurrence rate than patients who do not receive conservative treatment, which is almost without any controversy. Surgical treatment is usually the final treatment for patients with SV. However, there are multiple surgical methods for the treatment of SV, which can be roughly divided into resection and nonresection methods. The available evidence on the effectiveness of surgery for preventing postoperative recurrence is still inadequate. Therefore, we drafted this systematic review protocol with meta-analysis aimed to compare the effects of these two major types of surgery on preventing the recurrence of SV. We comprehensively and systematically reviewed the PubMed, EMBASE, MEDLINE and Cochrane Library databases of articles on SV from inception to November 16, 2023. Two independent authors will screen and analyze the detected literature, and disputes will be resolved through communication with a third experienced person. After evaluating the quality of the literature and estimating the risk of bias, we calculate the pooled effect size and 95% confidence interval. Heterogeneity is analyzed by subgroup analysis, and sensitivity analysis can be carried out to assure the reliability of the results. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to evaluate the strength of the evidence. The results of each analysis will be recorded in detail. The whole process was carried out in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines (PRISMA-P). Protocol registration: The study protocol has been registered at the International Prospective Register of Systematic Reviews platform (PROSPERO) (CRD42024508350). Protocol version 1.0, 13 Feb 2024.

Multiple relapses of sigmoid volvulus in a patient on automated peritoneal dialysis: the role of an elongated sigmoid colon and peritoneal dialysis as potential predisposing factors

Multiple relapses of sigmoid volvulus in a patient on automated peritoneal dialysis: the role of an elongated sigmoid colon and peritoneal dialysis as potential predisposing factors

Management of early recurrence following successful endoscopic detorsion in sigmoid volvulus.

Following endoscopic detorsion, sigmoid volvulus (SV) recurs in 3%-86% of patients, approximately 13% of which are early recurrence presenting during the first admission period. Although semielective surgery is the traditional approach, elective surgery following repetitive endoscopy or percutaneous endoscopic sigmoidopexy (PES) are other alternatives in the management of early SV recurrence. Our aim was to discuss the role of semielective surgery in above-mentioned rare clinical entity. Among our 1,076-case series, we retrospectively evaluated the records of 612 patients (56.9%) treated between June 1966 and June 1986, while we prospectively utilized the data of 464 patients (43.1%) managed between June 1986 and January 2024. We recorded the treatment option and prognosis for each patient. Early SV recurrence was determined in 34 (5.5%) of the 621 patients with successful nonoperative detorsion. We treated all of these patients by semielective surgery. The surgical procedures were detorsion in one patient (2.9%), mesopexy in 11 (32.4%), sigmoidectomy with primary anastomosis in 17 (50.0%), and sigmoidectomy with stoma in five (14.7%). In this series, mortality and morbidity rates were 2.9% (one patient) and 14.7% (five patients), respectively. Semielective surgery is the traditional approach tried by most surgeons, which allows for the recovery of the general status of the patients, bowel preparation, and antibiotic prophylaxis. However, repetitive endoscopy followed by elective surgery or PES are current alternatives for some selected patients. Unfortunately, the relatively low effectuation rate of elective surgery following successful repetitive endoscopic detorsion and recurrence-related poor prognosis are still important handicaps of the latter procedure.

Recurrence of Sigmoid Volvulus Associated With Constipation: A Retrospective Cohort Study.

Introduction Sigmoid volvulus is a gastrointestinal condition characterized by twisting the sigmoid colon, leading to obstruction and potentially severe complications. It is associated with factors such as advanced age, constipation, and the use of certain medications. Despite treatment, recurrence is common and significantly impacts patients' quality of life. This study aimed to identify factors influencing the recurrence of sigmoid volvulus to develop effective preventive strategies. Methods A retrospective cohort study was conducted at Fuchu Hospital, Osaka, including 44 patients diagnosed with sigmoid volvulus between May 2013 and May 2023. Data on variables such as age, gender, constipation, cardiac and neuropsychiatric diseases, hypertension, diabetes mellitus, sigmoid colon overgrowth, and BMI were collected from electronic medical records. Recurrence was defined as two or more diagnoses of sigmoid volvulus during the study period. Logistic regression analysis was used to identify significant predictors of recurrence. Results Of the 44 patients, 20 experienced recurrences. Single regression analysis identified constipation, neuropsychiatric disorders, and sigmoid colon overgrowth as significant factors. Logistic regression analysis confirmed constipation as an important predictor of recurrence (OR: 8.84, 95% CI: 2.05-38.1, p=0.0034). The area under thereceiver operating characteristic (ROC) curve for the model was 0.804 (95% CI: 0.67-0.938), indicating good predictive accuracy. Conclusion Constipation is a significant risk factor for the recurrence of sigmoid volvulus, likely due to chronic fecal overload leading to elongation and dilation of the sigmoid colon. Effective management of constipation is crucial in preventing recurrence. Future prospective studies with larger sample sizes are needed to validate these findings and explore additional preventive measures.

WP5.5 - Investigating the Optimal Timing for Definitive Treatment in Sigmoid Volvulus: A Retrospective Cohort Study

Abstract Aims The evidence base is replete of guidance on the optimal timing for definitive surgical management of acute sigmoid volvulus (ASV), with limited understanding or long-term outcomes for those managed conservatively. This study aimed to assess the management and outcomes of this understudied patient population. Methods A retrospective cohort study was conducted in a UK tertiary centre between January 2018 and December 2022. Results 69 patients presented with ASV (54M:15F, age 73.7 SD +/- 15.0 years). The median number of acute admissions per patient was 2 (IQR 1-4.5), with 29 patients (42.0%) presenting only once. 44 patients (63.8%) were managed conservatively. Of those patients, 22 (50.0%) were readmitted within the study period. 25 patients (26.2%) underwent operative management, with 18 (72.0%) of these patients undergoing emergency surgery (6 during their index admission, 33.3%). Elective surgical management was performed in 7 patients after an average of 3 previous admissions. All-cause mortality amongst the cohort was 47.8% (n=33), with a median life span of 1.1 years from index admission (IQR 0.3-2.6); 24.0% in the operative group (5 acute, 1 elective) versus 61.4% in the conservatively managed group. Conservatively managed patients were at greater odds of mortality compared to acutely operated patients (OR 4.129, 95% CI 1.25-13.67, p=0.02) and electively operated patients (OR 9.529, 95% CI 1.05-86.20, p=0.045). Acute operations had no significant greater odds of mortality compared to elective operations (p=0.49). Conclusions Conservative management of ASV was associated with greater odds of all-cause mortality compared to patients who received an operation. Operations performed in the acute setting had no greater mortality odds than in the elective setting.

FP2.11 - Management of Acute Sigmoid Volvulus – a 10-year retrospective review

Abstract Aims This study aims to review the management and outcomes of acute sigmoid volvulus within our Trust. Methods This was a retrospective study conducted at our NHS Trust. All adult patients presenting with SV between January 2012 and January 2022 were included. Data was collected from electronic patient records. Admission data included management (conservative only, CM, emergency surgery, ES, or planned surgery, PS), episode number, and 30-day mortality. Surgical data included ASA grade, complication rates, and bowel continuity rates. Results 219 patients (54.8% male, median age 72yrs) presented with acute SV. 87.2% patients were managed conservatively at index presentation, 44% of whom experienced recurrent SV. 27.4% patients received surgical management during follow-up (18.3% ES, 9.1% PS), none of whom experienced recurrence following surgery. The rate of ES increased linearly with total number of episodes, from 11% at index presentation to 25% at ≥5 episodes. 30-day mortality was 13.4% in the CM group, 15% in the ES group, and 0% in the PS group. Post-operative complication rate was 42.5% in the ES group and 5% in the PS group. Bowel continuity was achieved in 22.5% of ES patients and 60% of PS patients. Discussion Conservative management of SV was associated with a significant recurrence rate in our cohort. Repeat admissions were associated with an increasing incidence of ES, which was associated with worse outcomes compared with PS. We recommend all patients are considered for planned surgical intervention at index presentation to reduce recurrence and minimise the rate of emergency intervention.

Comparative analysis of short-term outcomes after semielective and elective surgery for sigmoid volvulus

BackgroundData to guide surgical timing after colonic decompression for sigmoid volvulus are limited. Thus, we compared the postoperative outcomes of patients with sigmoid volvulus who underwent semielective (during index hospitalization after decompression) and elective surgery (subsequent elective hospitalization). MethodsWe performed a retrospective review of 100% Medicare Provider Analysis and Review Files from 2016 to 2019, including Medicare beneficiaries aged ≥65 years who were urgently/emergently admitted for their index episode of volvulus and underwent colonic decompression followed by surgery. ResultsThe mean age of 2,053 patients was 78 (standard deviation 8 years); 7% had elective surgery and 93% had semielective surgery (including 12.5% on the same day as decompression). In a bivariate analysis, elective surgery was associated with greater rates of minimally invasive surgery (32.8% vs 12.6%, P < .001), lower rates of ostomy formation (2.9% vs 36.0%, P < .001), and greater rates of discharge home (89.8% vs 47.4%, P < .001) with similar cumulative length of stay (8 vs 9 days, not significant) compared with semielective surgery. In a multivariable logistic regression, elective surgery was associated with reduced odds of morbidity (odds ratio, 0.60; 95% confidence interval, 0.49–0.74) and similar odds of mortality (odds ratio, 0.79; 95% confidence interval, 0.50–1.25) compared with semielective surgery, which remained consistent after excluding patients with surgery on the same day as decompression. ConclusionsAfter colonic decompression for sigmoid volvulus, elective surgery appears safe and is associated with favorable outcomes compared with semielective surgery. With the potential severe consequences of volvulus recurrence, these findings underscore the need for algorithms to predict recurrence risk to help guide careful patient selection for elective surgery.

Endoscopic detorsion of sigmoid volvulus in a young female: a case report

BackgroundA volvulus refers to the torsion or rotational twisting of a portion of the gastrointestinal tract, with a predilection for impacting the caecum and sigmoid colon, often resulting in the development of bowel obstruction. The risk factors associated are old age, chronic fecal impaction, psychiatric disorders, colonic dysmotility, prior abdominal surgical procedures, diabetes, and Hirschsprung's disease. Elderly are most commonly affected with sigmoid volvulus but there are few cases among young adults that culminate in grave complications. Although it is rare, but young individuals presenting with acute abdomen secondary to sigmoid volvulus need urgent attention. To prevent more invasive surgical procedures, endoscopic detorsion is preferred nowadays with complete recovery of patients. We present a case of young female who was successfully managed with endoscopic detorsion.Case presentation27 years old Asian Pakistani female presented with worsening abdominal distention, constipation and vomiting since 2 days. On examination she was afebrile, vitally stable. Abdomen was distended, tympanic percussion with generalized tenderness. Abdominal radiograph was obtained which showed dilated bowel loops followed by Computed tomography of abdomen which was suggestive of Sigmoid volvulus causing intestinal obstruction. Patient was immediately moved to endoscopy unit and endoscopic detorsion of volvulus was done. For individuals who present with sigmoid volvulus and do not exhibit signs of peritonitis or colonic gangrene, the recommended course of action involves acute endoscopic detorsion, followed by scheduled surgical intervention.ConclusionThis case report emphasizes the significance of clinicians considering sigmoid volvulus as a rare but important cause when evaluating abdominal pain in young and otherwise healthy patients. A delay in diagnosis and treatment extending beyond 48 hours leads to colonic necrosis, amplifying the associated morbidity and mortality. Swift intervention is imperative to mitigate these complications and attain a conclusive remedy.

Management of Ileosigmoid Knotting: A Literature Review

Ileosigmoid knotting (ISK) is a rare double-segment intestinal obstruction form. Urgent surgery is the unique solution in the management of ISK. In surgical treatment, detorsion alone is generally used in patients with viable bowel, while cases with gangrenous bowel require resection. ISK recurrence is uncommon. However, due to the recurrence risk of sigmoid volvulus, the role of recurrence-reducing procedures is unclear. In this review, urgent treatment of ISK as well as the techniques and patient selection criteria of recurrence-reducing management are discussed.

Sigmoid volvulus with 25 episodes.

We report the case of a 74-year-old male with abdominal pain, distention and obstipation for 8 hours. He had a medical history of 24 sigmoid volvulus (SV) episodes, 23 of which treated with endoscopic detorsion, while one resolved spontaneously. Physical examination revealed abdominal distention, tenderness, hyperkinetic bowel sound and an empty rectum. Abdominal X-ray radiograph revealed dilated sigmoid loops with coffee bean sign. Computed tomography demonstrated dilated sigmoid loops with air-fluid levels and mesenteric whirl sign. Flexible colonoscopy showed a spiral-like luminal obstruction of the viable sigmoid colon at 18 cm from anal verge. A successful colonoscopic detorsion was performed. Due to the poor general health status of the patient (American Society of Anesthesiologists-ASA score 4) arising from serious comorbidities including coarctation of aorta and coronary disease, percutaneous endoscopic colostomy was suggested instead of elective sigmoid colectomy. He did not approve adjunctive therapy and was discharged following 24-hour observation.

Sigmoid volvulus-Can CT features predict outcomes and recurrence?

Sigmoid volvulus (SV) is a common cause of bowel obstruction, especially in older patients. SV can be mesenteroaxial (M-SV) or organoaxial (O-SV). The purpose of this study was to assess if CT findings in SV are associated with clinical outcomes. including recurrence, choice of management, and mortality. This study includes patients with SV and a CT within 24 hours of presentation. CT features, including mesenteraoxial/organoaxial arrangement, direction of rotation, transition points, distension, whirl-sign, ischemia, and perforation were determined. Demographics, treatment, recurrence, and outcome data were recorded. One hundred and seventeen cases were diagnosed in 80 patients (54 male). The mean age was 70 years (± 17.1). M-SV and O-SV were equally prevalent (n = 39 vs. n = 41, respectively). M-SV was significantly more common with anticlockwise rotation in the axial plane (p = 0.028) and clockwise rotation in the coronal plane (p = 0.015). All patients with imaging features of ischemia underwent surgery (n = 6). There was no significant difference in outcome variables (30-day mortality, 30-day readmission, recurrence) between the O-SV and M-SV groups. The degree of bowel distension on initial presentation was a significant predictor of recurrence, with ≥ 9 cm vs < 9 cm associated with an increased odds of any recurrence (OR: 3.23; 95%CI: 1.39-7.92). In SV, sigmoid distension of more than 9 cm at baseline CT was associated with an increased risk of recurrence. Imaging features of ischemia predicted surgical over endoscopic intervention. Organoaxial and mesenteroaxial SV had similar prevalence, but the type of volvulus was not associated with clinical outcomes or choice of management. There is a risk of recurrent sigmoid volvulus with colonic distension greater than 9 cm. This work, comparing volvulus subtypes, shows that this finding at the initial presentation could expedite consideration for surgical management. Reports of outcomes for different subtypes and rotational directions of volvuli have been contradictory. No difference in measured outcomes was found between subtypes; distension ≥ 9 cm predicted recurrence. CT features can aide management of sigmoid volvulus and can prompt surgical intervention.

Indications for Stoma Creation and Early Outcome Predictors of Stoma Closure at Universtiy of Dodoma Teaching Hospitals

Background: In advanced and developing countries stomas are commonly applied to clients, which can either be colostomy or ileostomy. These stomas are associated with post operative complications which might be the causal factors for the morbidity and mortality to our surgical patients. This study focus and analyse the indications of stoma creation, it also explores early outcome predictors of stoma closure. Objective: The aim of this study was to determine the indications for stoma creation and early outcome predictors of stoma closure. Methodology: The study was prospective, descriptive cross-sectional done at BMH, DRRH and IRRH from June 2021 to August 2022. The structured questionnaire was used as a tool for data collection. The information was obtained from patients, case notes or register book. Convenient sampling technique was used to select clients. Clavien-Dindo tool was used for grading severity of post-operative complications, chi-square, binary and multivariate logistic regression were used to establish association between predictor and outcome variables. SPSS was used for analysis. Results: A total of 194 subjects were enrolled in this study. There were 140 males (72.2%) and 54 females (27.8%) with male to female ratio of 3:1. Colostomy was the leading type of stoma created at 133 (68.6%) followed by ileostomy 61 (31.4%). Commonest indications for colostomy were sigmoid volvulus 75 (56.4%) and colo-rectal carcinoma 43 (32.3%). Ileostomy was commonly indicated in enteric perforation 24 (39.4%) and ileal trauma 20 (32.8%). Overall post-stoma closure complications were noted in 78 (40.2%), colostomy contributed by 60 (30.9%) and ileostomy at 18 (9.3%). The noted post-operative complications were deep &amp; organ/space SSI 52 (26.8%), AL &amp; ECF 21 (10.8%) and IO 05 (2.6%). Clavien-Dindo tool showed 78 (40.2%) unfavorable and 08 (4.1%) favorable outcomes. Binary logistic regression showed predictors of complications to be blood transfusion (p&lt;0.001), hypo-albuminemia (p&lt;0.001) and colostomy closure (p=0.041). Multivariate logistic regression showed hypo-albuminemia (p=0.002) a significant early outcome predictor of stoma closure. Conclusion: Hypo-albuminemia was shown to be important prognostic indicator for complications following stoma closure. The stomas were commonly indicated in sigmoid volvulus and enteric ileal perforation, and predominant post stoma closure complications were surgical site infection (SSI). Clavien-Dindo scoring system was also shown to be effective for grading severity of post-operative complications.