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- Title
Outcomes for sigmoid volvulus managed with and without early definitive surgery: 20‐year experience in a tertiary referral centre.
- Authors
Satheakeerthy, Shriranshini; Leow, Priscilla; Hall, Benjamin; Yen, Damien Ah; Fischer, Jesse
- Abstract
Background: Sigmoid volvulus is rare in Western countries. Patients at risk of sigmoid volvulus are often older with significant co‐morbidity. Without sigmoid colectomy there is a high recurrence rate, but indications for surgery are controversial. Methods: A retrospective observational study was conducted by reviewing clinical records of patients admitted to Waikato Hospital 1 January 2000 to 1 January 2020 with a diagnosis of sigmoid volvulus. Patient characteristics, clinical features, investigations, management, and outcomes were recorded. Results: One hundred and thirty‐two patients (87 male) were included with 203 volvulus episodes. Median age 76 years, median Charlson co‐morbidity index (CCI) 4. Median follow‐up 11 years. 44/132 (33.3%) had surgery during the index admission, two had elective surgery and the remainder had planned non‐operative management. 73/132 (55.3%) had surgery at any stage. 42/86 (48.8%) patients managed non‐operatively recurred; 66.7% of recurrences were within 6 months. Forty‐three (32.6%) died within 12 months of index admission; 28 (21.2%) died during an admission for volvulus. On univariate analysis higher age and abnormal vital signs were associated with inpatient and 12‐month mortality; higher CCI was associated with 12‐month mortality. On multi‐variate analysis increasing age in years was associated with increased risk of death (HR 1.089 [1.052–1.128, P < 0.001]). Normal vital signs at presentation were associated with decreased risk of death (HR 0.147 [0.065–0.334, P < 0.001]). Conclusion: Sigmoid colectomy should be considered at index presentation with sigmoid volvulus. Half of patients managed non‐operatively recurred, with two‐thirds recurring within 6 months. The mortality rate remains high for subsequent volvulus episodes.
- Subjects
WAIKATO (N.Z.); SIGMOID volvulus; MULTIVARIATE analysis; SURGERY; MEDICAL records; VOLVULUS; COLECTOMY; ELECTIVE surgery
- Publication
ANZ Journal of Surgery, 2024, Vol 94, Issue 1/2, p169
- ISSN
1445-1433
- Publication type
Article
- DOI
10.1111/ans.18671