Sigmoid colon torsion: mortality and relevant risk factors

European review for medical and pharmacological sciences (Impact Factor: 1.21). 01/2012; 17(1):127-132.


Sigmoid volvulus is an important acute intestinal obstruction, leading to high mortality and requiring urgent operation. The purpose of this study is to analyze risk factors for mortality in patients that were operated on due to sigmoid volvulus at our Department.

Materials and methods:
The retrospective study included 158 patients, who were operated on due to sigmoid volvulus between January 1994-December 2010, in terms of age, gender, complaints at admission, physical signs, period of symptoms before admission, associated diseases, laboratory and radiological parameters, hospital stay, morbidity, and mortality.

The study consisted of 135 men (85.4%) and 23 women (14.6%), with a mean age of 62.54 years. Cardiovascular disease and respiratory disease were present in 34 (21.5%) and 42 (26.6%) patients, respectively. Urgent operation was undertaken in 125, while 33 received elective surgery. Abdominal distension and pain was evident in all the patients. Generalized tenderness was detected in 58.2%, while 70.9% had hyperactive bowel sound with tympanism. Plain radiograph revealed an impression of "omega ans" in all patients, while free air was detected in 11.4% of them. Risk factors for mortality included age (p = 0.008), delayed admission (p = 0.001), cardiovascular and respiratory diseases (p = 0.001), fluid-electrolyte imbalance (p =0.001), presence of necrosis (p = 0.001), and major contamination (p = 0.001). Wound infection and intraabdominal abscess were more common in patients that developed mortality (p = 0.001 and p = 0.002).

Complications like wound infection and intraabdominal abscess are more frequent in the patients with the risk of mortality. Delayed admission results in higher risk of mortality. Mortality rates can be reduced by early admission, preoperative intensive resuscitation, suitable antibiotics, and emergent and viable surgery.

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Available from: Metehan Gumus, Sep 29, 2015
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    ABSTRACT: 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. This was a descriptive prospective study of patients operated for sigmoid volvulus at Bugando Medical Centre from March 2009 to February 2014. 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. 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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