M Roseano1, G Guarino, A Cuviello. 1. Università degli Studi di Trieste Dipartimento di Scienze Chirurgiche Generali, Anestesiologiche e Medicina Intensiva Unità Clinico Operativa Clinica Chirurgica Generale e Terapia Chirurgica.
Abstract
BACKGROUND: Sigmoid volvulus is associated with a high mortality because affects elderly patients who often have severe comorbid conditions that increase their surgical risk. OBJECTIVES: The aim of this study was to evaluate the most common procedures of diagnosis and treatments to obtain better results. METHODS: The clinical presentation, diagnosis and treatment of 10 consecutive patients with sigmoid volvulus are reviewed. Ages ranged from 30 to 93 years. Endoscopic decompression was tried in 6 and was successful in 3 cases. Seven patients had emergency surgery: surgical procedures were resection in 1 case and distortion with sigmoidopexy in 6; two patients had elective surgery after endoscopic decompression: surgical procedure was resection. RESULTS: All patients had abdominal pain. Other symptoms were constant only in the half of the cases. Significant was the correlation between leucocytosis and bowel ischaemia. Plain abdominal radiographs was not specific while sigmoidoscopy was diagnostic in all the cases. Two patients died: one after non operative reduction and another after emergency derotation and sigmoidopexy (operative mortality: 14%). The only complication was an anastomotic fistula. There were no recurrences at the time of follow-up (1-9 years after operation). CONCLUSION: Sigmoid volvulus is difficult to diagnose preoperatively and is associated with a high mortality. It may be diagnosed and treated by sigmoidoscopy followed by elective surgery. The treatment of choice is resection but good choice results can be obtained also with derotation and sigmoidopexy.
BACKGROUND:Sigmoid volvulus is associated with a high mortality because affects elderly patients who often have severe comorbid conditions that increase their surgical risk. OBJECTIVES: The aim of this study was to evaluate the most common procedures of diagnosis and treatments to obtain better results. METHODS: The clinical presentation, diagnosis and treatment of 10 consecutive patients with sigmoid volvulus are reviewed. Ages ranged from 30 to 93 years. Endoscopic decompression was tried in 6 and was successful in 3 cases. Seven patients had emergency surgery: surgical procedures were resection in 1 case and distortion with sigmoidopexy in 6; two patients had elective surgery after endoscopic decompression: surgical procedure was resection. RESULTS: All patients had abdominal pain. Other symptoms were constant only in the half of the cases. Significant was the correlation between leucocytosis and bowel ischaemia. Plain abdominal radiographs was not specific while sigmoidoscopy was diagnostic in all the cases. Two patients died: one after non operative reduction and another after emergency derotation and sigmoidopexy (operative mortality: 14%). The only complication was an anastomotic fistula. There were no recurrences at the time of follow-up (1-9 years after operation). CONCLUSION:Sigmoid volvulus is difficult to diagnose preoperatively and is associated with a high mortality. It may be diagnosed and treated by sigmoidoscopy followed by elective surgery. The treatment of choice is resection but good choice results can be obtained also with derotation and sigmoidopexy.
Authors: Roberto Cirocchi; Eriberto Farinella; Francesco La Mura; Umberto Morelli; Stefano Trastulli; Diego Milani; Micol S Di Patrizi; Barbara Rossetti; Alessandro Spizzirri; Ioanna Galanou; Konstandinos Kopanakis; Valerio Mecarelli; Francesco Sciannameo Journal: World J Emerg Surg Date: 2010-01-13 Impact factor: 5.469