Contemporary Management of Sigmoid Volvulus

  • Scott C. Dolejs
  • Michael J. Guzman
  • Alyssa D. Fajardo
  • Bryan K. Holcomb
  • Bruce W. Robb
  • Joshua A. Waters
Original Article
  • 139 Downloads

Abstract

Background

Sigmoid volvulus is an uncommon cause of bowel obstruction that is historically associated with high morbidity and mortality. The objective of this study was to evaluate contemporary management of sigmoid volvulus and the safety of primary anastomosis in patients with sigmoid volvulus.

Methods

The National Surgical Quality Improvement Project from 2012 to 2015 was queried for patients with colonic volvulus who underwent left-sided colonic resection. A propensity score-matched analysis was performed to compare patients with sigmoid volvulus undergoing colectomy with primary anastomosis without proximal diversion to colectomy with end colostomy.

Results

Two thousand five hundred thirty-eight patients with sigmoid volvulus were included for analysis. Patients had a median age of 68 years (interquartile range, 55–80) and 79% were fully independent preoperatively. Fifty-one percent of operations were performed emergently. One thousand eight hundred thirteen (71%) patients underwent colectomy with anastomosis, 240 (10%) colectomy with anastomosis and proximal diversion, and 485 (19%) colectomy with end colostomy. Overall, 30-day mortality and morbidity were 5 and 40%, respectively. After propensity score matching, mortality, overall morbidity, and serious morbidity were similar between groups.

Conclusions

Sigmoid volvulus occurs in elderly and debilitated patients with significant morbidity, mortality, and lifestyle implications. In selected patients, anastomosis without proximal diversion in patients with sigmoid volvulus results in similar outcomes to colectomy with end colostomy.

Keywords

Sigmoid volvulus Intestinal volvulus Colectomy Colostomy 

Notes

Author Contribution

Drs. Dolejs, Guzman, Fajardo, Holcomb, Robb, and Waters made substantial contributions to the conception of the work, revision of the work for important intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work. Drs. Dolejs and Waters made substantial contributions to the acquisition, analysis, and interpretation of data, and drafted the work.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Supplementary material

11605_2018_3747_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 14 kb)

References

  1. 1.
    Halabi WJ, Jafari MD, Kang CY, Nguyen VQ, Carmichael JC, Mills S et al. Colonic volvulus in the United States: trends, outcomes, and predictors of mortality. Ann Surg 2014;259(2):293–301.  https://doi.org/10.1097/SLA.0b013e31828c88ac.CrossRefPubMedGoogle Scholar
  2. 2.
    Akinkuotu A, Samuel JC, Msiska N, Mvula C, Charles AG. The role of the anatomy of the sigmoid colon in developing sigmoid volvulus: a case-control study. Clin Anat 2011;24(5):634–7.  https://doi.org/10.1002/ca.21131.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Swenson BR, Kwaan MR, Burkart NE, Wang Y, Madoff RD, Rothenberger DA et al. Colonic volvulus: presentation and management in metropolitan Minnesota, United States. Dis Colon Rectum 2012;55(4):444–9.  https://doi.org/10.1097/DCR.0b013e3182404b3d.CrossRefPubMedGoogle Scholar
  4. 4.
    Raveenthiran V, Madiba TE, Atamanalp SS, De U. Volvulus of the sigmoid colon. Color Dis. 2010;12(7 Online):e1–17.  https://doi.org/10.1111/j.1463-1318.2010.02262.x.Google Scholar
  5. 5.
    Heis HA, Bani-Hani KE, Rabadi DK, Elheis MA, Bani-Hani BK, Mazahreh TS et al. Sigmoid volvulus in the Middle East. World J Surg 2008;32(3):459–64.  https://doi.org/10.1007/s00268-007-9353-3.CrossRefPubMedGoogle Scholar
  6. 6.
    Muyembe VM, Suleman N. Intestinal obstruction at a provincial hospital in Kenya. East Afr Med J 2000;77(8):440–3.PubMedGoogle Scholar
  7. 7.
    Ballantyne GH, Brandner MD, Beart RW Jr, Ilstrup DM. Volvulus of the colon. Incidence and mortality. Ann Surg 1985;202(1):83–92.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Mangiante EC, Croce MA, Fabian TC, Moore OF 3rd, Britt LG. Sigmoid volvulus. A four-decade experience. Am Surg 1989;55(1):41–4.PubMedGoogle Scholar
  9. 9.
    Baker DM, Wardrop PJ, Burrell H, Hardcastle JD. The management of acute sigmoid volvulus in Nottingham. J R Coll Surg Edinb 1994;39(5):304–6.PubMedGoogle Scholar
  10. 10.
    Oren D, Atamanalp SS, Aydinli B, Yildirgan MI, Basoglu M, Polat KY et al. An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Colon Rectum 2007;50(4):489–97.  https://doi.org/10.1007/s10350-006-0821-x.CrossRefPubMedGoogle Scholar
  11. 11.
    Anderson JR, Lee D. The management of acute sigmoid volvulus. Br J Surg 1981;68(2):117–20.CrossRefPubMedGoogle Scholar
  12. 12.
    Atamanalp SS. Treatment of sigmoid volvulus: a single-center experience of 952 patients over 46.5 years. Tech Coloproctol 2013;17(5):561–9.  https://doi.org/10.1007/s10151-013-1019-6.CrossRefPubMedGoogle Scholar
  13. 13.
    Safioleas M, Chatziconstantinou C, Felekouras E, Stamatakos M, Papaconstantinou I, Smirnis A et al. Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly: a study of 33 cases. World J Gastroenterol 2007;13(6):921–4.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bruzzi M, Lefevre JH, Desaint B, Nion-Larmurier I, Bennis M, Chafai N et al. Management of acute sigmoid volvulus: short- and long-term results. Color Dis 2015;17(10):922–8.  https://doi.org/10.1111/codi.12959.CrossRefGoogle Scholar
  15. 15.
    Ali MK. Treatment of sigmoid volvulus: experience in Gondar, north-west Ethiopia. Ethiop Med J 1998;36(1):47–52.PubMedGoogle Scholar
  16. 16.
    Simon HE, Senturia HR, Keller TB. Volvulus of the sigmoid colon. Am J Surg 1946;71:550–2.CrossRefPubMedGoogle Scholar
  17. 17.
    Yassaie O, Thompson-Fawcett M, Rossaak J. Management of sigmoid volvulus: is early surgery justifiable? ANZ J Surg 2013;83(1–2):74–8.  https://doi.org/10.1111/j.1445-2197.2012.06182.x.CrossRefPubMedGoogle Scholar
  18. 18.
    Tan KK, Chong CS, Sim R. Management of acute sigmoid volvulus: an institution's experience over 9 years. World J Surg 2010;34(8):1943–8.  https://doi.org/10.1007/s00268-010-0563-8.CrossRefPubMedGoogle Scholar
  19. 19.
    Ballantyne GH. Review of sigmoid volvulus. Clinical patterns and pathogenesis. Dis Colon Rectum. 1982;25(8):823–30.CrossRefPubMedGoogle Scholar
  20. 20.
    Grossmann EM, Longo WE, Stratton MD, Virgo KS, Johnson FE. Sigmoid volvulus in Department of Veterans Affairs Medical Centers. Dis Colon Rectum 2000;43(3):414–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Kuzu MA, Aslar AK, Soran A, Polat A, Topcu O, Hengirmen S. Emergent resection for acute sigmoid volvulus: results of 106 consecutive cases. Dis Colon Rectum 2002;45(8):1085–90.CrossRefPubMedGoogle Scholar
  22. 22.
    Ballantyne GH. Review of sigmoid volvulus: history and results of treatment. Dis Colon Rectum 1982;25(5):494–501.CrossRefPubMedGoogle Scholar
  23. 23.
    Valsdottir E, Marks JH. Volvulus: small bowel and colon. Clin Colon Rectal Surg 2008;21(2):91–3.  https://doi.org/10.1055/s-2008-1075856. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Akcan A, Akyildiz H, Artis T, Yilmaz N, Sozuer E. Feasibility of single-stage resection and primary anastomosis in patients with acute noncomplicated sigmoid volvulus. Am J Surg 2007;193(4):421–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Oberkofler CE, Rickenbacher A, Raptis DA, Lehmann K, Villiger P, Buchli C et al. A multicenter randomized clinical trial of primary anastomosis or Hartmann’s procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg 2012;256(5):819–26; discussion 26–7.  https://doi.org/10.1097/SLA.0b013e31827324ba.CrossRefPubMedGoogle Scholar
  26. 26.
    Kingham TP, Pachter HL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg 2009;208(2):269–78.  https://doi.org/10.1016/j.jamcollsurg.2008.10.015.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Scott C. Dolejs
    • 1
  • Michael J. Guzman
    • 1
  • Alyssa D. Fajardo
    • 1
  • Bryan K. Holcomb
    • 1
  • Bruce W. Robb
    • 1
  • Joshua A. Waters
    • 1
  1. 1.Department of SurgeryIndiana University School of MedicineIndianapolisUSA

Personalised recommendations