Colonic Volvulus in the United States Trends, Outcomes, and Predictors of Mortality
ABSTRACT INTRODUCTION:: Colonic volvulus is a rare entity associated with high mortality rates. Most studies come from areas of high endemicity and are limited by small numbers. No studies have investigated trends, outcomes, and predictors of mortality at the national level. METHODS:: The Nationwide Inpatient Sample 2002-2010 was retrospectively reviewed for colonic volvulus cases admitted emergently. Patients' demographics, hospital factors, and outcomes of the different procedures were analyzed. The LASSO algorithm for logistic regression was used to build a predictive model for mortality in cases of sigmoid (SV) and cecal volvulus (CV) taking into account preoperative and operative variables. RESULTS:: An estimated 3,351,152 cases of bowel obstruction were admitted in the United States over the study period. Colonic volvulus was found to be the cause in 63,749 cases (1.90%). The incidence of CV increased by 5.53% per year whereas the incidence of SV remained stable. SV was more common in elderly males (aged 70 years), African Americans, and patients with diabetes and neuropsychiatric disorders. In contrast, CV was more common in younger females. Nonsurgical decompression alone was used in 17% of cases. Among cases managed surgically, resective procedures were performed in 89% of cases, whereas operative detorsion with or without fixation procedures remained uncommon. Mortality rates were 9.44% for SV, 6.64% for CV, 17% for synchronous CV and SV, and 18% for transverse colon volvulus. The LASSO algorithm identified bowel gangrene and peritonitis, coagulopathy, age, the use of stoma, and chronic kidney disease as strong predictors of mortality. CONCLUSIONS:: Colonic volvulus is a rare cause of bowel obstruction in the United States and is associated with high mortality rates. CV and SV affect different populations and the incidence of CV is on the rise. The presence of bowel gangrene and coagulopathy strongly predicts mortality, suggesting that prompt diagnosis and management are essential.
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ABSTRACT: Aim of the study The optimal treatment for acute sigmoid volvulus has not been defined. Our aim was to compare the results of two techniques for the management of uncomplicated sigmoid volvulus coming from two separate surgical services, which had each chosen a different technique: open surgical versus laparoscopic. Patients and methods Patients with sigmoid volvulus who underwent a surgical resection with immediate anastomosis, either emergency or scheduled, were included. Risk of morbidity (Dindo-Clavien criteria) and mortality (criteria of the AFC-French Association of Surgery) were evaluated. Results Thirteen patients in the open surgical group were operated in a 10-year period and 17 patients in the laparoscopy group were operated on in a seven-year period. The mean age (57 years in both groups) and sex ratio (0.7 versus 0.6, respectively), and the length of hospital stay (18 versus 15 days, respectively) were comparable in the two groups. The open surgical procedure was performed urgently in 62% (n = 8/13) versus 24% (n = 4/17) in the laparoscopic group. The two groups were comparable in terms of risk factors for mortality by AFC score. The anastomotic leak rate was 8% (n = 1/13) for the open surgical group versus 18% (n = 3/17) for the laparoscopic group, while serious morbidity was 15% (n = 2/13) versus 12% (n = 2/17). No recurrence of volvulus was observed in the open group (mean follow-up of 26 months) versus 12% (n = 2) in the laparoscopy group (mean follow-up of 32 months). Conclusion We did not find any significant difference between the two techniques. But the technical simplicity and the absence of recurrence in the open surgical group emphasize the importance of this technique.Journal of Visceral Surgery 09/2014; 151(6). DOI:10.1016/j.jviscsurg.2014.09.002
Journal of the American Geriatrics Society 10/2013; 61(10):1843-1844. DOI:10.1111/jgs.12484