Sigmoid volvulus: a 10-year-audit

Abstract

Background

Chronic constipation in elderly, institutionalised patients is the leading cause of sigmoid volvulus in the developed world. Endoscopic deflation is associated with a 90% recurrence rate and a 35% mortality rate.

Aims

To review a 10-year experience of sigmoid volvulus and encourage more aggressive primary treatment.

Methods

A retrospective study was performed on 16 patients with sigmoid volvulus from 1992 to 1999. Patients were identified using the hospital inpatient enquiry (HIPE) data system. Demographics, clinical course, intervention, complications and outcome were recorded.

Results

The male:female ratio was 5:3 and mean age was 78 years (range 39–92). Fifty per cent had at least one risk factor: Parkinson’s disease (n=3); multiple sclerosis (n=1); Alzheimer’s disease (n=1); and hypokalaemia (n=3). Thirty-seven per cent were managed conservatively and 63% required surgical intervention. Mean time to surgery was 2.4 days. Operations performed were sigmoid colectomy (45%), Hartmann’s procedure (33%) and total colectomy (22%). There was one post-operative death from myocardial ischaemia. Mean duration of admission was 21 days.

Conclusions

Endoscopic deflation of a sigmoid volvulus facilitates optimisation of cardiopulmonary co-morbidity in a high-risk group of patients. It converts an emergent to an elective procedure and minimises operative morbidity as a result.