Small bowel volvulus in the adult populace of the United States: results from a population-based study

Abstract

Background Small bowel volvulus is a rare entity in Western adults. Greater insight into epidemiology and outcomes may be gained from a national database inquiry. Methods The Nationwide Inpatient Sample (1998–2010), a 20% stratified sample of United States hospitals, was retrospectively reviewed for small bowel volvulus cases (ICD-9 560.2 excluding gastric/colonic procedures) in patients ≥18-years old. Results There were 2,065,599 hospitalizations for bowel obstruction (ICD-9 560.x). Of those, there were 20,680 (1.00%) small bowel volvulus cases; 169 were attributable to intestinal malrotation. Most cases presented emergently (89.24%) and operative management was employed more frequently than non-operative (65.21% vs. 34.79%, P<0.0001). Predictors of mortality included age >50-years, Charlson comorbidity index ≥1, emergent admission, peritonitis, acute vascular insufficiency, coagulopathy, and non-operative management (P<0.0001). Conclusions As the first population-based epidemiological study of small bowel volvulus, our findings provide a robust representation of this rare cause of small bowel obstruction in American adults.

Perioperative Outcomes and Predictors of Mortality After Surgery for Sigmoid Volvulus

“…Factors previously identified to influence mortality overall in sigmoid volvulus include age, shock on admission, previous volvulus episode, long period of symptoms before admission, cardiovascular disease history, chronic kidney disease, emergent status, necrosis/gangrene, peritonitis, coagulopathy, stoma use, and nonoperative management. 6,[22][23][24][25][26] The age range for individuals at risk varied from greater than 50-70 y of age. 22,24,26 This study contributes validation to previously described risk factors such as age, sepsis, and emergent status via a sample from the United States.…”

“…6,[22][23][24][25][26] The age range for individuals at risk varied from greater than 50-70 y of age. 22,24,26 This study contributes validation to previously described risk factors such as age, sepsis, and emergent status via a sample from the United States. However, the protective factors noted in our study such as independence before presentation, increased albumin levels before surgery, and lower BMI are novel.…”

Primary Small Bowel Volvulus: An Unusual Cause of Small Bowel Obstruction

“…SBV is an uncommon cause of small bowel obstruction [1]. Separated into primary and secondary causes, primary SBV is defined as SBV with no pre-existing anatomical abnormalities; whereas, secondary SBV occurs as a result of a myriad of anatomical pathologies including congenital abnormalities, bands, adhesions, and tumours [2].…”

“…Small bowel volvulus (SBV) is a rare surgical pathology with only 1% of small bowel obstruction being attributed to volvulus [1]. It occurs as a result of rotation of the gut lumen along an axis or mesenteric twisting causing obstruction [2].…”

Má rotação intestinal em adultos: um relato de caso e revisão da literatura / Malrotation in adults: a case report and literature review

“…Classicamente, a maioria dos casos de má rotação é diagnosticada durante o período neonatal ou primeiro ano de vida, porém recentemente a literatura mostra que há controvérsias, apresentando praticamente metade de casos em que o diagnóstico é feito durante a idade adulta, como aqui relatado, em que o diagnóstico ocorreu tardiamente. Quando isto ocorre, além de maiores índices de atraso e erro diagnóstico, a morbidade mostrou-se mais elevada quando com-parado a diagnósticos mais precoces, com maiores taxas de complicações perioperatórias e necessidade de reabordagem cirúrgica (4)(5)(6) .…”