Sigmoid volvulus in elderly patients

doi:10.1016/0002-9610(86)90014-0

The American Journal of Surgery

Volume 151, Issue 1, January 1986, Pages 71-75

https://doi.org/10.1016/0002-9610(86)90014-0 Get rights and content

Abstract

We reviewed the records of 51 patients over 65 years of age admitted for an initial episode of sigmoid volvulus, and adequate information about their subsequent course was obtained in 92 percent. Nonoperative reduction of the initial volvulus was attempted in 43 patients and was successful in 39 (91 percent). Eleven patients required emergency operations, with a mortality rate of 36 percent. Six patients had elective resections with no deaths. Thirty-three patients, 32 after nonoperative reduction of a volvulus and 1 after operative reduction, were discharged without definitive treatment. Twenty-three of the 33 patients (70 percent) managed by expectant observation had one or more episodes of recurrent volvulus. Five of the 23 patients died from the recurrence without operation, and 16 were operated on either emergently (3 patients) or electively (13 patients) after nonoperative reduction.

The mortality rate related to recurrent volvulus or its treatment in the 33 patients observed was 21 percent. The mortality rate for 18 elective resections (6 for initial volvulus and 12 for recurrent volvulus) was 5.6 percent. After successful nonoperative reduction of a sigmoid volvulus in elderly patients, maximal survival is achieved by early elective resection. Age alone is not an adequate reason for adopting a nonoperative approach.

References (10)

T Drapanas et al.
Acute sigmoid volvulus: concepts in surgical treatment
Am J Surg
(1961)
KD Wuepper et al.
An appraisal of the operative and nonoperative treatment of sigmoid volvulus
Surg Gynecol Obstet
(1966)
JR Hines et al.
Recurrence and mortality rates in sigmoid volvulus
Surg Gynecol Obstet
(1967)
GJ Arnold et al.
Volvulus of the sigmoid colon
Ann Surg
(1973)
GA Khoury et al.
Volvulus of the sigmoid colon
Br J Surg
(1977)

There are more references available in the full text version of this article.

Cited by (94)

To Resect or Not to Resect: A Nationwide Comparison of Management of Sigmoid Volvulus
2024, Journal of Surgical Research
Despite the high recurrence rate of sigmoid volvulus, there is reluctance to perform a prophylactic colectomy in frail patients due to the operation's perceived risks. We used a nationally representative database to compare risk of recurrence in patients undergoing a prophylactic colectomy versus endoscopic detorsion alone.
We performed a retrospective cohort study using the National Readmission Database (2016-2019) including patients aged ≥18 y who had an emergent admission for sigmoid volvulus and underwent endoscopic detorsion on the day of admission. We performed a 1:1 propensity matching adjusting for patient demographics, frailty score comprising of 109 components, and hospital characteristics. Our primary outcome was readmission due to colonic volvulus and secondary outcomes included mortality, complications, length of stay (LOS), and costs during index admission and readmission. We performed a subgroup analysis in patients with Hospital Frailty Score >5.
We included 2113 patients of which 1046 patients (49.5%) underwent a colectomy during the initial admission. In the matched population of 830 pairs, readmission due to colonic volvulus was significantly lower in patients undergoing endoscopy followed by colectomy than endoscopy alone. Patients undergoing a colectomy had higher gastric and renal complications, longer LOS, and higher costs but no difference in mortality. In the subgroup analysis of frail patients, readmission was significantly lower in patients with prophylactic colectomy with no significant difference in mortality in 439 matched patients.
Prophylactic colectomy was associated with lower readmission, a higher rate of complications, increased LOS, and higher costs compared to sigmoid decompression alone.
Sigmoid volvulus: Evaluating identification strategies and contemporary multicenter outcomes
2023, American Journal of Surgery
There is limited epidemiologic data on sigmoid volvulus (SV) from non-endemic regions. Therefore, we performed a multicenter study to report contemporary outcomes and appraise literature-based methods that pair diagnostic and procedural codes to identify SV.
Using an automated search for patients with ‘volvulus’ in our system from 2011 to 2021, we reviewed electronic charts to clarify the diagnosis, automatically replicate three strategies to identify SV, and retrieved 6-month outcomes.
Of 895 patients, 109 had SV. Literature-based strategies poorly identified SV. At the index admission, patients underwent endoscopic reduction alone (33%), emergent (16.5%), semi-elective (34%), or elective (16.5%) surgery. Endoscopic reduction alone had high recurrence rates and delayed surgery was associated with worse outcomes.
Literature-based strategies to identify SV suffer from misclassification bias which affects patient counseling. In this large series, one-third of patients do not undergo during their index admission despite improved outcomes with earlier surgery.
Colonic Intussusception and Volvulus
2019, Shackelford's Surgery of the Alimentary Tract: 2 Volume Set
Intussusception occurs when a proximal segment of intestine invaginates into a distal segment of intestine. Intussusception is categorized into two discrete categories: small intestinal and colonic. Computed tomography (CT) is the most accurate diagnostic modality for intussusception. In adults, the pathologic lead point is a gastrointestinal (GI) malignancy in up to 56% of cases. With this in mind, the treatment is resection without reduction. Colonic volvulus occurs when a segment of colon undergoes torsion along its own mesentery resulting in obstruction. This is a rare case of obstruction in the Western world and is more common in areas such as Africa, the Middle East, and South America. Sigmoid volvulus is the most common form of colonic volvulus and occurs when a chronically redundant sigmoid colon becomes torsed along a chronically elongated mesentery. Plain radiography can be diagnostic for sigmoid volvulus; however, a number of characteristic findings can be seen on both barium enema and CT. Endoscopy is successful in achieving decompression of sigmoid volvulus in 60% to 90% of cases and should be an initial treatment measure in the stable patient. Resection should process in a semielective fashion due to the high rate of recurrence and associated mortality. Cecal volvulus occurs when incomplete fixation of the cecum allows for torsion. Cecal bascule is a similar condition in which the cecum folds cephalad resulting in a “flap-valve” obstruction. Cecal volvulus affects a younger cohort compared to sigmoid volvulus. Various imaging modalities aid in the diagnosis of cecal volvulus. Endoscopic decompression is unsuccessful for reduction of cecal volvulus and treatment is operative. Rare forms of colonic volvulus include transverse colon volvulus and ileosigmoid knotting. Diagnosis of these entities often occurs at the time of laparotomy owing to their rare nature and nonspecific presenting symptoms. Resection is the mainstay of treatment and is dictated by the extent of necrosis present.
Sigmoid volvulus: Diagnosis and urgent treatment
2018, Journal Europeen des Urgences et de Reanimation
Un patient de 88 ans consulte aux urgences pour des douleurs abdominales évoluant depuis trois jours. L’examen clinique retrouve un abdomen distendu, météorisé, douloureux à la palpation. Le transit est conservé à raison de trois selles liquides par jour. Le scanner abdominopelvien avec injection de produit de contraste iodé met en évidence un volvulus sigmoïdien avec distension colique en amont. L’endoscopie colique réalisée en urgence permet le franchissement du volvulus et sa détorsion, une colo exsufflation et un lavage-aspiration colique. L’évolution immédiate est simple. Le volvulus récidive cinq jours après l’endoscopie, nécessitant une nouvelle colo exsufflation avec détorsion. Le patient regagne son domicile après onze jours d’hospitalisation, avec prescription de laxatifs et de lavements rectaux quotidiens. La discussion décrit l’épidémiologie, le diagnostic, les complications et le traitement urgent du volvulus du sigmoïde.
A 88 year old patient consults to the ED for abdominal pain lasting for three days. Clinical examination found a distended abdomen, weathered, painful on palpation. Transit is preserved with three loose stools per day. The abdominopelvic scan with iodine injection shows a sigmoid volvulus with upstream colonic distension. Endoscopy allows the crossing of the volvulus and untwisting a exsufflation colo and a suction-colic. Immediate change is simple. Volvulus recurrence five days after endoscopy, requiring a new colo exsufflation with untwisting. The patient returns to his home after eleven days of hospitalization, prescription laxatives and enemas daily rectal. The discussion describes the epidemiology, diagnosis, complications and emergency treatment of sigmoid volvulus.
Massive sigmoid volvulus
2016, Surgery (United States)
Abdominal Pain in the Geriatric Patient
2016, Emergency Medicine Clinics of North America
Citation Excerpt :
Similar to a SBO, patients classically present with abdominal pain, vomiting, and constipation/obstipation, although diarrhea is seen in one-fifth of patients, and only one-half will report constipation or vomiting.20 Similar to SBOs in this age group, large-bowel obstructions are commonly only discovered late in their course and accordingly have a high mortality, ranging from 12% to 50%.21 Sigmoid and cecal volvulus account for a smaller subset of large-bowel obstructions, but more often requires emergent surgical intervention.22

View all citing articles on Scopus

^☆: Presented at the 26th Annual Meeting of the Society for Surgery of the Alimentary Tract, New York, New York, May 14–15, 1985.

¹: From the Department of Surgery, Albert Einstein College of Medicine-Monteflore Medical Center, New York, New York.

View full text

Scientific paperSigmoid volvulus in elderly patients☆

Abstract

Am J Surg

An appraisal of the operative and nonoperative treatment of sigmoid volvulus

Surg Gynecol Obstet

Recurrence and mortality rates in sigmoid volvulus

Surg Gynecol Obstet

Volvulus of the sigmoid colon

Ann Surg

Volvulus of the sigmoid colon

Br J Surg

Scientific paper
Sigmoid volvulus in elderly patients☆