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Kazem Shahmoradi M, Khoshdani Farahani P, Sharifian M. Evaluating outcomes of primary anastomosis versus Hartmann's procedure in sigmoid volvulus: A retrospective-cohort study. Ann Med Surg (Lond) 2021; 62:160-163. [PMID: 33520215 PMCID: PMC7820798 DOI: 10.1016/j.amsu.2021.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study is to compare the short outcomes of two methods of sigmoid resection and primary anastomosis with sigmoid resection and end colostomy (Hartmann's procedure) for sigmoid volvulus. Methods This retrospective study included 102, of which 56 patients underwent end colostomy (Hartmann's procedure) and 46 patients underwent resection and primary anastomosis for sigmoid volvulus. The medical records of the patients were reviewed to evaluate the patients' characteristics, operative data, short-term postoperative outcomes and mortality. Results The mean age of patients in the groups of Hartmann's procedure and primary anastomosis were 68.23 ± 13.42 and 70.10 ± 12.71, respectively. From the 46 patients who had primary colorectal anastomosis, 2 patients (4.3%) suffered from anastomosis leakage, which was not significantly different. This study showed that anastomosis leakage, prolonged ileus, bleeding, surgical site infection and fascial dehiscence were not different between Hartmann's procedure and primary anastomosis, significantly, p < 0.05. Hospital stay in the Hartmann group was less than primary anastomosis group in the same admission, p = 0.04. The mortality rate was not statistically different among the two groups, p = 0.549. Conclusions Postoperative complications and mortality rate do not different among the two groups however, the duration of hospitalization was lesser in Hartmann's procedure group.
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Affiliation(s)
- Mohammad Kazem Shahmoradi
- Department of General Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Parham Khoshdani Farahani
- Department of General Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Masoud Sharifian
- Department of General Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Sarfaraz M, Hasan SR, Lateef S. Sigmoid volvulus in young patients: Ą new twist on an old diagnosis. Intractable Rare Dis Res 2017; 6:219-223. [PMID: 28944147 PMCID: PMC5608935 DOI: 10.5582/irdr.2017.01033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
According to the literature, sigmoid volvulus typically develops in patients of an older age with co-morbidities such as a psychiatric illness or a bed-bound chronic illness. Recent reports suggest that it should also be considered in young individuals without any preceding medical history. Abdominal roentgenography is a cheap and effective diagnostic modality that can avoid a delay in diagnosis. The treatment of colonic volvulus remains controversial and relies upon the procedure selected and the most appropriate therapeutic approach in terms of the clinical status of the patient, the location of the problem, the suspected existence or identification of peritonitis, bowel viability, and the expertise of the surgical team. Presented here are four cases of young male patients with sigmoid volvulus. All of the patients were diagnosed radiologically prior to surgical intervention. Two of the patients initially underwent an endoscopic procedure that succeeded in one and that failed in the other. Three of the patients underwent a laparotomy.
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Affiliation(s)
- Moaziz Sarfaraz
- Emergency Department, Fujairah Hospital, Fujairah, United Arab Emirate
- Address correspondence to: Dr. Moaziz Sarfaraz, Emergency Department, Fujairah Hospital, Fujairah, U.A.E. E-mail:
| | - Syeda Rana Hasan
- Department of Preventive Medicine, Fujairah, United Arab Emirate
| | - Shahid Lateef
- Department of Surgery, Kalba Hospital, Kalba, Sharjah, United Arab Emirate
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Iida T, Nakagaki S, Satoh S, Shimizu H, Kaneto H, Nakase H. Clinical outcomes of sigmoid colon volvulus: identification of the factors associated with successful endoscopic detorsion. Intest Res 2017; 15:215-220. [PMID: 28522952 PMCID: PMC5430014 DOI: 10.5217/ir.2017.15.2.215] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 12/03/2022] Open
Abstract
Background/Aims Although multiple treatment options exist for the management of sigmoid colon volvulus, no study has examined the factors associated with successful endoscopic detorsion. This study aimed to examine the clinical course of patients with sigmoid colon volvulus and to identify factors related to successful endoscopic detorsion. Methods This study included 30 cases (21 patients) of sigmoid volvulus from among 545 cases of intestinal obstruction at a single center. We retrospectively examined the clinical course and the factors associated with the possibility of endoscopic detorsion of sigmoid colon volvulus. Results The rate of laxative use among the study participants was 76.2%; the rate of comorbid neuropsychiatric disorders was 61.9%; and 57.1% of patients had a history of open abdominal surgery. All patients were initially treated with endoscopic detorsion, and this procedure had a 61.9% success rate. The recurrence rate after detorsion was as high as 46.2%, but detorsion during revision endoscopy was possible in all cases. Statistical analysis revealed that the absence of abdominal tenderness (P=0.027), the use of laxatives (P=0.027), and a history of open abdominal surgery (P=0.032) were factors predictive of successful endoscopic detorsion. Conclusions The results of our study are consistent with previous reports with respect to the success rate of endoscopic detorsion, the subsequent recurrence rate, and the proportion of patients requiring surgical treatment. In addition, we identified the absence of abdominal tenderness, the use of laxatives, and history of open abdominal surgery as factors predicting successful endoscopic detorsion of sigmoid colon volvulus.
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Affiliation(s)
- Tomoya Iida
- Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan
| | - Suguru Nakagaki
- Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan
| | - Shuji Satoh
- Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan
| | - Haruo Shimizu
- Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan
| | - Hiroyuki Kaneto
- Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Abstract
Volvulus of the intestines may involve either the small bowel or colon. In the pediatric population, small bowel volvulus is more common, while in the adult population, colonic volvulus is more often seen. The two most common types of colonic volvulus include sigmoid and cecal volvulus. Prompt diagnosis and treatment is imperative, otherwise bowel ischemia may ensue. Treatment often involves emergent surgical exploration and bowel resection.
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Affiliation(s)
- Muneera R Kapadia
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Comparison of primary resection and anastomosis with Hartmann’s procedure in management of acute sigmoid volvulus. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s13126-016-0329-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chalya PL, Mabula JB. Sigmoid volvulus and ileo-sigmoid knotting: a five-year experience at a tertiary care hospital in Tanzania. World J Emerg Surg 2015; 10:10. [PMID: 25774209 PMCID: PMC4359572 DOI: 10.1186/s13017-015-0001-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 01/26/2015] [Indexed: 11/21/2022] Open
Abstract
Background Sigmoid volvulus is a common cause of intestinal obstruction in developing countries where it affects relatively young people compared to developed countries. No prospective study has been done on this subject in Tanzania and Bugando Medical Centre in particular. This study describes in our region, the clinical presentation, management and outcome of sigmoid volvulus. Methods This was a descriptive prospective study of patients operated for sigmoid volvulus at Bugando Medical Centre from March 2009 to February 2014. Results A total of 146 patients (M: F = 5.1: 1) representing 14.2% of all cases of bowel obstruction were studied. The median age at presentation was 48 years. The disease significantly affected the older males compared with females (P = 0.012). The majority of the patients 102, (93.2%) presented acutely and had to undergo emergency surgical intervention, the rest were either sub-acute or chronic. Out of the 146 patients studied, 24 (16.4%) had ileo-sigmoid knotting. The majority of patients, 102(69.9%) were treated with resection and primary anastomosis, of which 63.0% were emergency cases. Colostomy was offered to 30.1% of cases. No patient had sigmoidoscopic derotation. Complications mainly surgical site infections were reported in 20.5% of cases. The overall median length of hospital stay was 14 days. Overall mortality rate was 17.1%. The main predictors of mortality were advanced age (>60 years), concomitant medical illness, late presentation (≥24 hours), presence of shock on admission and presence of gangrenous bowel (P < 0.001). The follow up of patients in this study was generally poor as more than half of patients were lost to follow up. Conclusion Sigmoid volvulus is not uncommon in our setting and commonly affects males than females. Most of the patients presented acutely, requiring immediate resuscitation and surgical approach. Findings from this study suggest that in viable bowel, sigmoid resection and primary anastomosis is feasible as it may not adversely affect outcome. Temporary colostomy should be considered if the bowel is gangrenous or perforated. Early diagnosis and timely definitive treatment are essential in order to decrease the morbidity and mortality associated with this disease.
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Affiliation(s)
- Phillipo L Chalya
- Department of Surgery, Catholic University of Health and Allied Science-Bugando, Mwanza, Tanzania
| | - Joseph B Mabula
- Department of Surgery, Catholic University of Health and Allied Science-Bugando, Mwanza, Tanzania
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Traoré D, Sanogo Z, Bengaly B, Sissoko F, Coulibaly B, Togola B, Traoré I, Goïta D, Keïta S, Togo A, Diallo G, Sangaré D, Ongoïba N, Koumaré A. Acute sigmoid volvulus: Results of surgical treatment in the teaching hospitals of Bamako. J Visc Surg 2014; 151:97-101. [DOI: 10.1016/j.jviscsurg.2014.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
BACKGROUND AND OBJECTIVES Sigmoid gangrene develops in 6.1% to 93.4% of sigmoid volvulus (SV) cases, and increases the mortality rate from 0% to 40% without bowel gangrene to 3.7% to 80%. This study aimed to investigate factors that induce bowel gangrene development in SV patients. DESIGN AND SETTINGS Retrospective study from a single center. PATIENTS AND METHODS We determined whether there was any correlation between sigmoid gangrene and the following factors: age, gender, a previous history of a volvulus, previous history of abdominal surgery, pregnancy, major comorbidities, shock, duration of symptoms, direction and degree of rotation of volvulus, and ileosigmoid knotting. RESULTS Of 442 patients, 271 (61.3%) had sigmoid gangrene. The presence of pregnancy was negatively cor.related with sigmoid gangrene development (P < .05), while comorbid diseases (P < .01), associated shock (P < .01), prolonged symptom duration (P < .05), overrotation (P < .05), and associated ileosigmoid knotting (P < .01) were positively correlated with bowel gangrene. However, no correlation was observed between sigmoid gangrene and the other studied factors. CONCLUSION An inverse correlation between pregnancy and sigmoid gangrene was observed. On the other hand, a positive correlation was noted between bowel gangrene and comorbid diseases, shock, prolonged duration of symptoms, overrotation, and associated ileosigmoid knotting.
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Affiliation(s)
- Sabri Selcuk Atamanalp
- Faculty of Medicine, Department of General Surgery, Ataturk University, Erzurum 25070, Turkey.
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Mnguni MN, Islam J, Manzini V, Govindasamy V, Zulu BMW, Clarke DL, Madiba TE. How far has the pendulum swung in the surgical management of sigmoid volvulus? Experience from the KwaZulu-Natal Teaching Hospitals and review of the literature. Colorectal Dis 2012; 14:1531-7. [PMID: 22487185 DOI: 10.1111/j.1463-1318.2012.03046.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM Sigmoid volvulus is common in sub-Saharan Africa. The aim of the study was to document the clinicopathological patterns of sigmoid volvulus in KwaZulu-Natal. METHOD Analysis was performed of prospectively collected data of patients presenting with sigmoid volvulus at the KwaZulu-Natal Teaching Hospitals from 2000 to 2009. Data collected included demographics, clinical presentation, operative findings, management and outcome. RESULTS There were 135 patients (122 male) of mean age 39.3 ± 17 years. Management was by emergency surgery (103), elective surgery (23), no surgery (9). The level of the twist was at the pelvic brim. Fifty-four patients had gangrenous bowel and 81 had viable bowel. Resection was accompanied by primary anastomosis (80) and Hartmann's procedure (46). Complication and mortality rates were 47% and 17% respectively. Mortality rates for emergency and elective surgery were 19% and 9% (P = 0.330), and those for primary anastomosis and Hartmann's procedure were 14% and 24% respectively (P = 0.305). Mortality rates for gangrenous and viable bowel were 21% and 15% respectively (P = 0.624). Twenty-eight (22%) patients required intensive care in the intensive care unit (ICU) with an ICU stay of 8.8 ± 8 days. Hospital stay was 10.5 ± 14.4 days. CONCLUSION The clinicopathological picture of sigmoid volvulus resembles that in the rest of Africa in that it affects predominantly young African males. The level of the twist is at the pelvic brim. The timing of surgery, the type of anastomosis and the viability of the bowel does not influence outcome.
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Affiliation(s)
- M N Mnguni
- Department of Surgery, University of KwaZulu-Natal Teaching Hospitals, Congella, South Africa
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10
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Sigmoid volvulus treated by resection and primary anastomosis: urgent and elective conditions as risk factors for postoperative morbidity and mortality. Eur J Trauma Emerg Surg 2012; 38:463-6. [PMID: 26816129 DOI: 10.1007/s00068-012-0191-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 04/09/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Sigmoid volvulus is a major cause of intestinal obstruction. The aim of this study is to analyze urgent and elective conditions as risk factors for morbidity and mortality regarding sigmoid colon resection and primary anastomosis in patients with sigmoid volvulus. METHODS This retrospective study included 63 patients diagnosed with sigmoid volvulus, who underwent sigmoid colon resection plus primary anastomosis under urgent or elective conditions between January 1994 and December 2010. RESULTS Sigmoid colon resection plus anastomosis was performed in 63 patients; 31 (49.2 %) under urgent conditions, while 32 (50.8 %) were performed electively. The mean age of the patients was 65.2 ± 15.2 (18-95) years. The patients consisted of 50 (79.4 %) men and 13 (20.6 %) women. There were no statistical significances between groups in terms of age, gender, associated diseases, and hospital stay. Postoperative morbidity occurred in 30.2 % of patients. The morbidity rates for the urgent group and the elective group were 35.5 and 25.0 %, respectively (p = 0.419). Wound infection, pneumonia, and evisceration were the most common postoperative complications. Wound infection was higher in the urgent group (p = 0.026). In terms of other complications, the groups were similar. Total mortality occurred in 19.4 % of the urgent group and 15.6 % of the elective group (p = 0.750). CONCLUSION Sigmoid colon resection plus primary anastomosis-related morbidity and mortality rates were similar in patients who were operated on under urgent and elective conditions, and who maintained good general condition.
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Osiro SB, Cunningham D, Shoja MM, Tubbs RS, Gielecki J, Loukas M. Article Commentary: The Twisted Colon: A Review of Sigmoid Volvulus. Am Surg 2012. [DOI: 10.1177/000313481207800331] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sigmoid volvulus (SV) is the third leading cause of colon obstruction in adults. In infants and children, it is exceedingly rare with only sporadic cases reported so far. SVs from secondary causes, with congenital megacolon being the most important, are nevertheless more common in young people. The etiology of this disorder is not completely understood. It is known to occur in the setting of redundant sigmoid loop, which rotates around its narrow and elongated mesentery. Although the latter occurs in the setting of constipation, a congenitally elongated colon, and other predisposing factors, there is no consensus on the precipitating factor leading to SV formation. The symptoms are suggestive of small bowel obstruction, but the presentations can be acute or indolent. Plain abdominal radiography is used to diagnose SV in most cases with computed tomography scan or magnetic resonance imaging as the confirmatory tests when necessary. After it has been untwisted, the definitive and standard therapy for SV is sigmoid resection and primary anastomosis. The nonresective alternatives have also been widely used with mixed success, but a large, randomized controlled trial is needed to compare their efficacy with resection and primary anastomosis. Laparoscopic surgery in SV management is unwarranted and costly. Complications of SV include hemorrhagic infarction, perforation, septic shock, and death. The mortality data from SV vary, but the latest literature cites an overall range of 14 to 45 per cent.
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Affiliation(s)
- Stephen B. Osiro
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies; the, Birmingham, Alabama
| | - Debbie Cunningham
- Department of Radiology, Boston University, Boston, Massachusetts; the, Birmingham, Alabama
| | - Mohammadali M. Shoja
- Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - R. Shane Tubbs
- Pediatric Neurosurgery, Children's Hospital, Birmingham, Birmingham, Alabama; and the, Olsztyn, Poland
| | - Jerzy Gielecki
- Department of Anatomy, Medical School, Varmia and Mazuria, Olsztyn, Poland
| | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies; the, Birmingham, Alabama
- Department of Anatomy, Medical School, Varmia and Mazuria, Olsztyn, Poland
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Martin MJ, Steele SR. Twists and turns: a practical approach to volvulus and intussusception. Scand J Surg 2010; 99:93-102. [PMID: 20679045 DOI: 10.1177/145749691009900210] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M J Martin
- Trauma and Emergency Surgery Service, Legacy Emanuel Hospital, Portland, OR, USA.
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Akcan A, Akyildiz H, Artis T, Yilmaz N, Sozuer E. Feasibility of single-stage resection and primary anastomosis in patients with acute noncomplicated sigmoid volvulus. Am J Surg 2007; 193:421-6. [PMID: 17368281 DOI: 10.1016/j.amjsurg.2006.08.077] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 08/16/2006] [Accepted: 08/16/2006] [Indexed: 12/16/2022]
Abstract
BACKGROUND The management of sigmoid volvulus remains controversial. The aim of this study was to evaluate the feasibility of treating sigmoid volvulus by using a single-stage resection and anastomosis versus a 2-stage approach. METHODS A total of 136 patients with noncomplicated sigmoid volvulus who had undergone emergency surgery within the last 15 years were evaluated retrospectively. Sigmoid resection plus Hartmann colostomy was performed in 45 patients, and sigmoid resection plus primary anastomosis was performed in 91 patients. In 40 of the patients who underwent a Hartmann procedure, we performed a second operation for colostomy closure (HC&CC group). RESULTS There were no significant differences among the groups with regard to age, sex, morbidity, reoperation because of complications, mortality rates, and duration of intensive care unit stay (P > .05). The duration of hospital stay was significantly longer in the HC&CC group than in the other groups (P < .001). CONCLUSIONS In cases without the complications of perforation or gangrene, sigmoid resection with immediate anastomosis was feasible. Single-stage operations did not increase morbidity or mortality rates, and patients required a shorter hospital stay than those who had undergone 2-stage operations.
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Affiliation(s)
- Alper Akcan
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey.
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Safioleas M, Chatziconstantinou C, Felekouras E, Stamatakos M, Papaconstantinou I, Smirnis A, Safioleas P, Kostakis A. Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly: A study of 33 cases. World J Gastroenterol 2007; 13:921-4. [PMID: 17352024 PMCID: PMC4065930 DOI: 10.3748/wjg.v13.i6.921] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery.
METHODS: 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.
RESULTS: 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%.
CONCLUSION: 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.
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Affiliation(s)
- Michael Safioleas
- 2nd Department of Propedeutic Surgery, School of Medicine, Athens University, Laiko Hospital, 7 Kyprou Ave, Filothei, Athens 15237, Greece.
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Abstract
OBJECTIVE The purpose of this study was to describe the clinical profile of patients with sigmoid volvulus and highlight the diagnostic difficulties and pitfalls. METHODS This was a retrospective descriptive study of patients with sigmoid volvulus seen at a community hospital over a 5-year period from July 1999 to July 2004. RESULTS Twenty-eight cases of sigmoid volvulus were identified, of which 16 were male and 12 female. The median age was 74 years. Twenty-seven were Chinese and one was Malay. Seven out of 28 patients were from nursing institutes while the rest came from their own homes. Eleven were bedridden and chronic constipation was a problem for 17 patients. Co-existing medical illnesses, including neuropsychiatric conditions, were common. Abdominal distension and pain were the most frequent presentations (26 and 21 patients, respectively). Twelve patients had constipation and 11 had diarrhoea. Only nine had the complete typical triad of abdominal distension, pain and constipation. The classical coffee-bean sign was identified in nine out of 26 initial plain abdominal radiographs done at the emergency department and a further 11 were diagnosed after review by the surgical team in the ward. Another four were identified only after computed tomography scan of the abdomen and pelvis. The remaining two patients were diagnosed intra-operatively after they underwent emergency laparotomy. CONCLUSIONS As our aged population continues to grow, sigmoid volvulus may be more commonly encountered. Emergency physicians should maintain a high index of suspicion and avoid the pitfalls so as to prevent delay in diagnosis and treatment.
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Affiliation(s)
- Ling Tiah
- Accident and Emergency Department, Changi General Hospital, Singapore, Republic of Singapore.
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16
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Raveenthiran V. Restorative resection of unprepared left-colon in gangrenous vs. viable sigmoid volvulus. Int J Colorectal Dis 2004; 19:258-63. [PMID: 14530993 DOI: 10.1007/s00384-003-0536-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2003] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Emergency resection and primary anastomosis of unprepared left-colon is a controversial subject. Although this approach has been reported in several series, there is paucity of data on the relative safety of it in viable vs. gangrenous colon especially when the gut is unprepared. PATIENTS AND METHODS Case records of 57 consecutive patients with acute sigmoid volvulus were reviewed; there were 27 with gangrenous colon (group G) and 30 with viable colon (group V). All of them had undergone emergency resection and primary anastomosis without on-table lavage or caecostomy. RESULTS Group G had a lower mean haemoglobin value (8.4 vs. 9.7 g/dl) and higher incidence of circulatory shock on admission (26% vs. 7%) and required more blood transfusion (85% vs. 53%) than group V. Mean hospital stay (16 vs. 12 days), overall anastomotic leak (15% vs. 27%) and mortality (3.5% vs. 3%) did not differ significantly between the groups. However, the rate of wound infection in Group G was four times greater than that of group V. CONCLUSION One-stage restorative resection without on-table lavage or caecostomy appears to be a promising alternative in the emergency management of acute sigmoid volvulus. Comparison of primary anastomosis in gangrenous vs. viable colon did not reveal any significant difference in hospital stay, rate of anastomotic leak or mortality. However, the risk of wound infection was more in patients with gangrenous sigmoid volvulus.
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Affiliation(s)
- V Raveenthiran
- Department of Surgery, Veer Surendra Sai Medical College, Burla, Sambalpur, Orissa, India.
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Mehendale VG, Chaudhari NC, Mulchandani MH. Laparoscopic sigmoidopexy by extraperitonealization of sigmoid colon for sigmoid volvulus: two cases. Surg Laparosc Endosc Percutan Tech 2003; 13:283-5. [PMID: 12960795 DOI: 10.1097/00129689-200308000-00013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sigmoid colectomy-open or laparoscopic-has been advocated as the treatment of sigmoid volvulus. This has a higher incidence of morbidity and mortality. We have successfully treated 2 cases of recurrent sigmoid colon volvulus with laparoscopic sigmoidopexy by extraperitonealization of the sigmoid colon. Laparoscopic sigmoidopexy by this technique has not been reported before. The first patient was a 20-year-old male and the second was a 72-year-old female. In both patients, initial detorsion of volvulus was achieved by rectal tube. As the colon was nongangrenous, elective laparoscopic sigmoidopexy by extraperitonealization of the sigmoid colon was performed 4 days after the detortion. Operative times were 50 minutes and 70 minutes. Both patients were discharged from the hospital on the third postoperative day. There has been no recurrence of volvulus over a period of 6 and 7 months. There were no complications. In conclusion, laparoscopic sigmoidopexy by extraperitonealization of the sigmoid colon may become a superior alternative for the treatment of sigmoid volvulus with nongangrenous colon.
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Affiliation(s)
- Vinay G Mehendale
- Department of Surgery, Seth VC Gandhi & MA Vora Municipal General Hospital, Mumbai, India.
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Abstract
An 84-year-old female who was found unexpectedly dead at her home was shown at autopsy to have a massively dilated sigmoid colon with twisting of the lower colon on an unusually long mesentery. The volvulus had caused mechanical obstruction of the bowel with critical reduction of the blood supply resulting in intestinal infarction. Death was due to ischaemic necrosis of the lower large intestine with significant fluid and electrolyte sequestration within the bowel lumen, associated with disseminated sepsis. Gastrointestinal disorders that may result in unexpected death are uncommon in adults and may present atypically in the elderly. The diagnosis of unexpected death due to an infarcted sigmoid volvulus may not be established until an autopsy has been undertaken.
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Affiliation(s)
- M Pannell
- Forensic Science Centre, Adelaide, Australia
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