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World J Gastroenterol. Feb 14, 2007; 13(6): 921-924
Published online Feb 14, 2007. doi: 10.3748/wjg.v13.i6.921
Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly: A study of 33 cases
Michael Safioleas, Constantinos Chatziconstantinou, Evangelos Felekouras, Michael Stamatakos, Ioannis Papaconstantinou, Anastasios Smirnis, Panagiotis Safioleas, Alkiviades Kostakis
Michael Safioleas, Michael Stamatakos, Anastasios Smirnis, Panagiotis Safioleas, Alkiviades Kostakis, 2nd Department of Propedeutic Surgery, School of Medicine, Athens University, Laiko Hospital, Greece
Constantinos Chatziconstantinou, Department of Radiology, Laiko Hospital, Athens, Greece
Evangelos Felekouras, Ioannis Papaconstantinou, 1st Department of Surgery, School of Medicine, Athens University, Laiko Hospital, Greece
Author contributions: All authors contributed equally to the work.
Correspondence to: Professor Michael Safioleas, MD, PhD, 2nd Department of Propedeutic Surgery, School of Medicine, Athens University, Laiko Hospital, 7 Kyprou Ave, Filothei, Athens 15237, Greece. stamatakosmih@yahoo.gr
Telephone: +30-210-6812188
Received: October 18, 2006
Revised: November 15, 2006
Accepted: December 25, 2006
Published online: February 14, 2007
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.

Keywords: Volvulus; Celiotomy; Large bowel obstruction; Decompression; Sigmoidectomy