Sigmoid volvulus: 10-year report from Maharat Nakhon Ratchasima Hospital

Abstract

Introduction: Sigmoid volvulus is an uncommon cause of colonic obstruction in adults. There have been fewer reports of sigmoid volvulus in Thailand. The aims of this study were to assess characteristics and outcomes of treatment in patients who were diagnosed with sigmoid volvulus at Maharat Nakhon Ratchasima Hospital over a 10-year period. Methods: This retrospective study included 42 sigmoid volvulus patients between 01/2010 and 12/2019. Patients’ characteristics, investigations for diagnosis, operative details and postoperative outcomes were analyzed. Results: From 42 sigmoid volvulus patients, 34 (80%) were males with average age of 64.6 years. Two most common co-morbidities were hypertension (33.3%) and bedridden status (14.2%). Classic “Coffee bean” sign on plain abdominal radiography was found in 33 patients (78.6%). Colonoscopic detorsion was attempted in 17 patients (40.5%) with a success rate of 76.5%. From 13 patients who had successful detorsion, only 5 patients (38.5%) underwent sigmoidectomy with primary anastomosis in the same index admission. Overall 30-day mortality rate was 9.5% and mortality rate was 10.3% for emergency surgery. Conclusions: Sigmoid volvulus usually presents in elderly patients. Endoscopic detorsion should be the initial management of patients without peritonitis. Sigmoidectomy should be done in the same index admission.