Reliability of AXIS Classification System for Prediction of Sigmoid Volvulus Severity

Abstract

This study aimed at evaluating reliability of AXIS classification system in predicting severity of sigmoid volvulus. This retrospective study included 60 patients diagnosed as sigmoid volvulus in Minia University Hospital, Egypt, from January 2014 to January 2019. According to abdominal X-ray coffee-bean sign mesenteric axis, patients were classified into three groups: group 1, mesenteric axis of 0–90°; group 2, 90–135°; group 3, > 135° from horizontal. Treatment options included endoscopic detorsion followed by elective sigmoidectomy for patients without severe abdominal pain or intestinal necrosis; otherwise, open sigmoidectomy was performed. Analyzed patients’ data included: age, sex, body mass index (BMI), American Society of Anesthesiologists physical status (ASA) score, intestinal necrosis, need for surgery, 30 days mortality, and hospital stay. Sixty patients included 38 for group 1, 20 for group 2, and 2 patients for group 3. Mean age was 71.2 years. Forty-six patients were males, and 14 patients were females. ASA score was ≥ 2 in 56 patients (93.3%). Forty-eight patients (80%) underwent endoscopic detorsion only. Four patients (6.7%) underwent endoscopic detorsion followed by elective sigmoidectomy with primary anastomosis. Eight patients (13.3%) underwent sigmoidectomy and Hartmann’s procedure without endoscopic intervention. Two patients (3.3%) had complications. Intestinal necrosis and need for surgery were significantly associated with AXIS classification. AXIS classification can be used as predictive factor for severity of sigmoid vovulus in early stage of patient’s assessment. However, further prospective studies with large population number are needed to validate this system.