Diseases of the Colon & Rectum

, Volume 43, Issue 3, pp 414–418 | Cite as

Sigmoid volvulus in Department of Veterans Affairs Medical Centers

  • Erik M. Grossmann
  • Walter E. Longo
  • Michael D. Stratton
  • Katherine S. Virgo
  • Frank E. Johnson
Original Contributions


PURPOSE: Sigmoid volvulus is the third leading cause of large-bowel obstruction. The optimal management strategy remains controversial. This study was undertaken to evaluate the care of patients with sigmoid volvulus recently treated at Department of Veterans Affairs hospitals. METHODS: All patients with the International Classification of Diseases, Ninth Revision, Clinical Modification, Third Edition code for colonic volvulus during the period 1991 to 1995 were identified in the computerized national Department of Veterans Affairs database. Data on patient demographics, clinical course, and outcomes were analyzed. RESULTS: Two hundred twenty-eight patients had volvulus of the sigmoid colon and sufficient clinical data for evaluation. The mean age was 70; all were males. Endoscopic decompression was attempted in 189 of 228 (83 percent) patients and was successful in 154 of 189 (81 percent). Management included celiotomy in 178 of 228 (78 percent) patients. There were no intraoperative deaths. Twenty-five of 178 (14 percent) patients died within 30 days of surgery. The mortality rate was 24 percent for emergency operations (19/79), and 6 percent for elective procedures (6/99). Mortality was correlated with emergent surgery (P<0.01) and necrotic colon (P<0.05). Among those 50 patients managed by decompression alone, six (12 percent) died during the index admission. Ten of the remaining 44 (23 percent) patients eventually developed recurrent volvulus requiring further treatment, and 2 of 10 (20 percent) patients died. CONCLUSIONS: In this cohort sigmoid volvulus often presents as a surgical emergency. Initial endoscopic decompression resolves the acute obstruction in the majority of cases. Surgical intervention carries a substantial risk of mortality, particularly in the setting of emergent surgery or in the presence of necrotic colon.

Key words

Sigmoid volvulus Celiotomy Intestinal obstruction Decompression Colon Outcomes 


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  1. 1.
    Ballantyne GH. Review of sigmoid volvulus: clinical patterns and pathogenesis. Dis Colon Rectum 1982;25:823–30.PubMedGoogle Scholar
  2. 2.
    Ballantyne GH, Brandner MD, Beart RW Jr, Ilstrup DM. Volvulus of the colon: incidence and mortality. Ann Surg 1985;302:83–92.Google Scholar
  3. 3.
    Frizelle FA, Wolff BG. Colonic volvulus. Adv Surg 1996;29:131–9.PubMedGoogle Scholar
  4. 4.
    Ballantyne GH. Review of sigmoid volvulus: history and results of treatment. Dis Colon Rectum 1982;25:494–501.PubMedGoogle Scholar
  5. 5.
    Bruusgaard C. Volvulus of the sigmoid colon and its treatment. Surgery 1947;22:466–78.Google Scholar
  6. 6.
    Hines JR, Geurkink RE, Bass RT. Recurrence and mortality rates in sigmoid volvulus. Surg Gynecol Obstet 1967:567–70.Google Scholar
  7. 7.
    Arnold GJ, Nance FC. Volvulus of the sigmoid colon. Ann Surg 1973;177:527–37.PubMedGoogle Scholar
  8. 8.
    Ballantyne GH. Sigmoid volvulus: high mortality in county hospital patients. Dis Colon Rectum 1981;24:515–20.PubMedGoogle Scholar
  9. 9.
    Siroospour D, Berardi RS. Volvulus of the sigmoid colon: a ten-year study. Dis Colon Rectum 1976;19:535–41.PubMedGoogle Scholar
  10. 10.
    Mangiante EC, Croce MA, Fabian TC, Moore OF, Britt LG. Sigmoid volvulus: a four decade experience. Am Surg 1989;55:41–4.PubMedGoogle Scholar
  11. 11.
    Wertkin MG, Aufses AH Jr, Management of volvulus of the colon. Dis Colon Rectum 1978;21:40–5.PubMedGoogle Scholar
  12. 12.
    Bak MP, Boley SJ. Sigmoid volvulus in elderly patients. Am J Surg 1986;151:71–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Page WF, Braun MM, Caporaso NE. Ascertainment of mortality in the U.S. veteran population: World War II veteran twins. Mil Med 1995;160:351–5.PubMedGoogle Scholar
  14. 14.
    Fisher SG, Weber L, Goldberg J, Davis F. Mortality ascertainment in the veteran population: alternatives to the National Death Index. Am J Epidemiol 1995;141:242–50.PubMedGoogle Scholar
  15. 15.
    Rennie JA. Peptic ulceration and sigmoid volvulus in India. Ann Coll Surg Engl 1981;63:105–7.Google Scholar
  16. 16.
    Agrawal RL, Misra MK. Volvulus of the sigmoid colon. Int Surgery 1971;55:49–56Google Scholar
  17. 17.
    Rennie JA. Sigmoid volvulus. J R Soc Med 1979;72:654–6.PubMedGoogle Scholar
  18. 18.
    Ojara EA. Sigmoid volvulus in Kenyatta national hospital—1976–1980. East Afr Med J 1983;60:290–6.PubMedGoogle Scholar
  19. 19.
    Astini C, Falaschi CF, Mariam M, Desta A. The management of sigmoid volvulus: report of 39 cases. Ital J Surg Sci 1988;18:127–9.PubMedGoogle Scholar
  20. 20.
    Arigbabu AO, Badejo OA, Akinola DO. Colonoscopy in the emergency treatment of colonic volvulus in Nigeria. Dis Colon Rectum 1985;28:795–8.PubMedGoogle Scholar
  21. 21.
    Degiannis E, Levy RD, Sliwa K, Hale MJ, Saadia R. Volvulus of the sigmoid colon at Baragwanath hospital. S Afr J Surg 1996;34:25–8.PubMedGoogle Scholar
  22. 22.
    Udezue NO. Sigmoid volvulus in Kaduna Nigeria. Dis Colon Rectum 1990;33:647–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Habr-Gama AH, Haddad J, Simonsen O,et al. Volvulus of the sigmoid colon in Brazil: a report of 230 cases. Dis Colon Rectum 1976;19:314–20.PubMedGoogle Scholar
  24. 24.
    Asbun HJ, Castellanos H, Balderrama B,et al. Sigmoid volvulus in the high altitude of the Andes: review of 230 cases. Dis Colon Rectum 1992;35:350–3.CrossRefPubMedGoogle Scholar
  25. 25.
    Northeast AD, Dennison AR, Lee EG. Sigmoid volvulus: new thoughts on the epidemiology. Dis Colon Rectum 1984;27:260–1.PubMedGoogle Scholar
  26. 26.
    Jones IT, Fazio VW. Colonic volvulus: etiology and management. Dig Dis 1989;7:203–9.PubMedGoogle Scholar
  27. 27.
    Ghazi A, Shinya H, Wolff WI. Treatment of volvulus of the colon by colonoscopy. Ann Surg 1976;183:263–5.PubMedGoogle Scholar
  28. 28.
    Bhatnagar BN, Roy SK, Chakravarty MR. Comparative evaluation of the commonly performed emergency procedures for the prevention of recurrence of sigmoid volvulus. Am J Proctol 1977;25:35–44.Google Scholar
  29. 29.
    Pählman L, Enbald P, Rudberg C, Krog M. Volvulus of the colon: a review of 93 cases and current aspects of treatment. Acta Chir Scand 1989;155:53–6.Google Scholar
  30. 30.
    Morrissey TB, Deitch EA. Recurrence of sigmoid volvulus after surgical intervention. Am Surg 1994;60:329–31.PubMedGoogle Scholar
  31. 31.
    Caruso DM, Kassir AA, Robles RA,et al. Use of trephine stoma in sigmoid volvulus. Dis Colon Rectum 1996;39:1222–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Chung RS. Colectomy for sigmoid volvulus. Dis Colon Rectum 1997;40:363–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Chung CC, Kwok SP, Leung KL, Kwong KH, Lau WY, Li AK. Laparoscopy-assisted sigmoid colectomy for volvulus. Surg Laparosc Endosc 1997;7:423–5.CrossRefPubMedGoogle Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 2000

Authors and Affiliations

  • Erik M. Grossmann
    • 1
  • Walter E. Longo
    • 1
  • Michael D. Stratton
    • 1
  • Katherine S. Virgo
    • 1
  • Frank E. Johnson
    • 1
  1. 1.From the Surgical Service, Department of Veterans Affairs Medical Center and Department of Surgery, SaintLouis University Health Sciences CenterSt. Louis

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