Dilemma of sigmoid volvulus management

Abstract

Introduction Patients with sigmoid volvulus (SV) are at a high risk of recurrence with increased morbidity and mortality. This study aims to review whether patients with SV underwent definitive surgical treatment after initial endoscopic reduction according to the guidelines, and to compare mortality rate between surgical and conservative management. Methods Retrospective study conducted at East Kent Hospitals University NHS Foundation Trust, included all patients with SV between 2016 and 2018. The primary outcome was 30-day mortality following the initial management of the acute attack. Secondary outcomes were recurrence rate and overall mortality. The median follow-up period was 3 years. Results A total of 40 patients were identified with a median age of 82 years; 27 (67%) were males. Of these 40 patients, 6 (15%) had emergency surgery, 26 (65%) received endoscopic decompression only, and 8 (20%) had planned definitive resection; 32 patients (80%) had recurrence and the median interval between any two episodes was 86 days. The mortality rate among patients with ASA grade 3 or 4 in the three groups, elective surgery, emergency surgery and decompression only, was 0%, 25% and 70% respectively, whereas it was 0%, 50% and 33% in those with ASA grade 2. The mortality rate among patients with similar ASA who had a planned surgery was significantly lower compared with those who did not undergo surgery (p=0.003). Conclusions In patients with sigmoid volvulus, regardless of ASA grade, performing early definitive surgery following initial endoscopic decompression resulted in a statistically significant lower mortality rate.

Outcomes for sigmoid volvulus managed with and without early definitive surgery: 20‐year experience in a tertiary referral centre

“…With rare exceptions in non-Western populations 13 and database studies, 14 case series are often small with less than 100 patients included due to the relative rarity of the condition. 8,[15][16][17] In conclusion, this large series of patients presenting with sigmoid volvulus has demonstrated a high recurrence and mortality rate, in the setting of a relatively low rate of definitive surgical management. Careful selection of patients for surgical resection is important and a multi-disciplinary shared decision-making model recommended.…”

“…Cumulative observational data is therefore instructive in informing management of this condition. With rare exceptions in non‐Western populations 13 and database studies, 14 case series are often small with less than 100 patients included due to the relative rarity of the condition 8,15–17 …”

Unveiling a Coalescing Catastrophe: Pre-pyloric Perforation Co-existing With Sigmoid Volvulus in a Middle-Aged Patient

“…The co-existence of sigmoid volvulus and pre-pyloric perforation was observed in this case, which was assumed to be an outcome of the H. pylori infection in the patient six months back. Endoscopic intestinal decompression can be preferred in uncomplicated cases of sigmoid volvulus; however, surgical resection has been associated with decreased recurrence [ 11 ]. A research by Choi et al reported majority of the patients of their study were relieved by non-surgical decompression, though recurrence was observed in patients without subsequent surgical correction, which was managed by Hartman's procedure on grounds of differential colonic diameter leading to better and efficient outcomes in such patients [ 12 ].…”

Sigmoid Volvulus and Ileosigmoid Knotting: An Update

“…In SV, following a rapid and effective resuscitation, endoscopic decompression is the primary treatment option with 55%-94% of success, 0%-2% of mortality, 2%-20% of morbidity, and 15%-55% of recurrence rates. 1 , 2 , 4 , 21 , 24 , 48 , 62 , 66 , 68 - 70 For this purpose, rigid or preferably flexible endoscopes are used. Although flatus tubes are traditionally used following decompression, their recurrence preventive role is debated.…”

“…In gangrenous cases, following the resection of gangrenous sigmoid colon, primary anastomosis (mortality 5%-10%, morbidity 10%-30%, and recurrence 0%-1%) is preferred in the restoration of the bowel continuity, while stoma is life-saving in elderly and bad-conditioned cases (mortality 20%-30%, morbidity 10%-30%, and recurrence 0%-1%). 1 , 2 , 4 , 8 , 21 , 24 , 27 , 38 , 58 , 59 , 62 , 66 , 68 - 70 …”