Sigmoid volvulus: High mortality in county hospital patients

Abstract

Between 1970 and 1980, 12 patients were admitted 16 times to San Bernardino County Medical Center for sigmoid volvulus. The seven men and five women averaged 68.5 years old. Sixty-seven per cent recounted histories of neuropsychiatric disorders. Fifty per cent had been institutionalized. Forty-two per cent had endured previous episodes of sigmoid volvulus. Fourteen of 24 nonoperative attempts at reduction were successful but were followed by nine recurrences. Ten of 12 patients eventually underwent surgery. Eight procedures were electively scheduled following spontaneous or nonoperative reductions. Two emergency procedures for gangrenous colons were required. Both of these patients died. Mortality following elective surgery was 25 per cent. Twenty-nine major complications followed the ten procedures. All ten patients underwent sigmoid resections. Follow-up disclosed only two living patients. Only five had survived one year following initial hospitalization and only two for two years. The high mortality of this and other American series was attributed to the frail nature of the elderly, debilitated, institutionalized patients with neuropsychiatric and multiple medical disorders, who develop sigmoid volvulus in the United States.