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Rafaqat W, Lagazzi E, McChesney S, Smith MC, UrRahman M, Lee H, DeWane MP, Khan A. To Resect or Not to Resect: A Nationwide Comparison of Management of Sigmoid Volvulus. J Surg Res 2024; 297:101-108. [PMID: 38484451 DOI: 10.1016/j.jss.2023.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/29/2023] [Accepted: 12/24/2023] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Despite the high recurrence rate of sigmoid volvulus, there is reluctance to perform a prophylactic colectomy in frail patients due to the operation's perceived risks. We used a nationally representative database to compare risk of recurrence in patients undergoing a prophylactic colectomy versus endoscopic detorsion alone. METHODS We performed a retrospective cohort study using the National Readmission Database (2016-2019) including patients aged ≥18 y who had an emergent admission for sigmoid volvulus and underwent endoscopic detorsion on the day of admission. We performed a 1:1 propensity matching adjusting for patient demographics, frailty score comprising of 109 components, and hospital characteristics. Our primary outcome was readmission due to colonic volvulus and secondary outcomes included mortality, complications, length of stay (LOS), and costs during index admission and readmission. We performed a subgroup analysis in patients with Hospital Frailty Score >5. RESULTS We included 2113 patients of which 1046 patients (49.5%) underwent a colectomy during the initial admission. In the matched population of 830 pairs, readmission due to colonic volvulus was significantly lower in patients undergoing endoscopy followed by colectomy than endoscopy alone. Patients undergoing a colectomy had higher gastric and renal complications, longer LOS, and higher costs but no difference in mortality. In the subgroup analysis of frail patients, readmission was significantly lower in patients with prophylactic colectomy with no significant difference in mortality in 439 matched patients. CONCLUSIONS Prophylactic colectomy was associated with lower readmission, a higher rate of complications, increased LOS, and higher costs compared to sigmoid decompression alone.
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Affiliation(s)
- Wardah Rafaqat
- Division of Trauma, Emergency General Surgery, and Surgical Critical care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emanuele Lagazzi
- Division of Trauma, Emergency General Surgery, and Surgical Critical care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shannon McChesney
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael C Smith
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mujeeb UrRahman
- Department of Surgery, District Headquarters Hospital, Buner, Pakistan
| | - Hanjoo Lee
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Michael P DeWane
- Division of Trauma, Emergency General Surgery, and Surgical Critical care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aimal Khan
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
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Yamani AS, Morris MC, Schrager JJ, Athota KP, Sams VG. A case of acute colonic pseudo-obstruction, sigmoid volvulus, and massive pneumoperitoneum in a young female patient. Int J Surg Case Rep 2024; 117:109558. [PMID: 38518469 PMCID: PMC10972842 DOI: 10.1016/j.ijscr.2024.109558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Acute colonic pseudo-obstruction (ACPO) is an uncommon phenomenon that is especially rare in young patients and can result in bowl ischemia and perforation if left untreated. Furthermore, pneumoperitoneum is almost always a concerning imaging finding and in the context of recent colonic resection may be a sign of anastomotic leakage. CASE PRESENTATION We describe a case of a young female patient with postpartum ACPO who subsequently underwent a hemicolectomy with colorectal anastomosis. The patient's hospital course was complicated by massive postoperative pneumoperitoneum that resulted in resection of the anastomosis and creation of an end colostomy. However, despite this measure, there was recurrent pneumoperitoneum on cross-sectional imaging 36 h later. This was treated non-operatively and the remainder of their hospital course was uneventful. CLINICAL DISCUSSION A potential etiology for ACPO during pregnancy may be due to compression of parasympathetic plexus nerves by the gravid uterus. Idiopathic pneumoperitoneum has been documented on a number of occasions, though this is generally in older patients. It can present with signs of peritonitis or can be asymptomatic. Simultaneous pneumothorax and pneumoperitoneum is rare and may be due to the transmission of air from the peritoneum to the mediastinum and thorax. The pneumoperitoneum itself may be due the air leakage through the significantly distended colon into the peritoneum. CONCLUSION The combination of ACPO following pregnancy and associated pneumothorax, pneumomediastinum, and recurrent pneumoperitoneum suggest a communicating defect between the thoracic, mediastinal, and peritoneal cavities. Furthermore, the possibility of underlying colonic dysmotility should be considered prior to the restoration of large bowel continuity.
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Affiliation(s)
- Ali S Yamani
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Mackenzie C Morris
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Jason J Schrager
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Krishna P Athota
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Valerie G Sams
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
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Schabl L, Holubar SD, Erozkan K, Alipouriani A, Sancheti H, Steele SR, Kessler H. Epidemiology and age-related trends in surgical outcomes for sigmoid volvulus: a 17-year analysis. Langenbecks Arch Surg 2024; 409:37. [PMID: 38217626 DOI: 10.1007/s00423-024-03228-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Sigmoid volvulus, a gastrointestinal disorder characterized by twisted bowel, often requires medical intervention, either through endoscopic or surgical means, to avoid potentially severe outcomes. This study examined the challenges elderly patients face in undergoing surgical treatment, encompassing both mortality and morbidity. Furthermore, it aimed to determine how medical practices and outcomes have changed over a period of 17 years. METHODS We utilized data from the National Surgical Quality Improvement Project, which covers the period from 2005 to 2021, to identify patients who underwent left hemicolectomy for colonic volvulus. The patients were categorized into three age groups: < 60 years, 60-75 years, and > 75 years. We performed a meticulous logistic regression analysis, carefully adjusted for risk factors, to compare mortality, morbidity, and types of surgical treatment administered among the different age groups. RESULTS Our study included 6775 patients. The breakdown of the patient population was as follows: 2067 patients were < 60 years of age, 2239 were between 60 and 75 years of age, and 2469 were > 75 years of age. The elderly cohort, those aged above 75 years, were predominantly male, had lower BMIs, underwent fewer laparoscopic surgeries, required more diverting stomas and end-ostomies, and had longer hospital stays. Notably, the elderly population faced a mortality risk that was 5.67 times (95% CI 3.64, 9.20) greater than that of their youngest counterparts, with this risk increasing by 10% (95% CI 1.06, 1.14) for each additional year of age. Furthermore, the odds of mortality associated with emergency surgery were 1.63 times (95% CI 1.21, 2.22) higher than those associated with elective surgery. The postoperative morbidity odds were also elevated for emergency surgeries, 1.30 times (95% CI 1.08, 1.58) greater than that for elective cases. Over the 17-year period, we observed a decline in mortality rates, an increase in the utilization of laparoscopic procedures, and overall stability of morbidity rates. CONCLUSION Our findings highlight the increased vulnerability of patients over 75 years of age, who are not only at an elevated risk of mortality compared to their younger counterparts, but also a continuously increasing risk with age. By focusing on elective surgeries for younger patients and minimizing emergency surgeries for the elderly, it may be possible to reduce the mortality risk associated with surgical interventions in this population.
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Affiliation(s)
- Lukas Schabl
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
- Department for General, Visceral, and Thoracic Surgery, University Hospital Salzburg, Salzburg, Austria.
| | - Stefan D Holubar
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kamil Erozkan
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Alipouriani
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Himani Sancheti
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Scott R Steele
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hermann Kessler
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
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Arnold SC, Rafaqat W, Abiad M, Lagazzi E, Hoekman AH, Panossian VS, Nzenwa IC, Paranjape CN, Velmahos GC, Kaafarani HMA, Hwabejire JO. Patience is key: Association of surgical timing with clinical outcomes in elderly patients with sigmoid volvulus. Am J Surg 2024:S0002-9610(24)00009-6. [PMID: 38278705 DOI: 10.1016/j.amjsurg.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Current guidelines for sigmoid volvulus recommend endoscopy as a first line of treatment for decompression, followed by colectomy as early as possible. Timing of the latter varies greatly. This study compared early (≤2 days) versus delayed (>2 days) sigmoid colectomy. METHODS 2016-2019 NRD database was queried to identify patients aged ≥65 years admitted for sigmoid volvulus who underwent sequential endoscopic decompression and sigmoid colectomy. Outcomes included mortality, complications, hospital length of stay, readmissions, and hospital costs. RESULTS 842 patients were included, of which 409 (48.6 %) underwent delayed sigmoid colectomy. Delayed sigmoid colectomy was associated with reduced cardiac complications (1.1 % vs 0.0 %, p = 0.045), reduced ostomy rate (38.3 % vs 29.4 %, p = 0.013), an increased overall length of stay (12 days vs 8 days, p < 0.001) and increased overall costs (27,764 dollar vs. 24,472 dollar, p < 0.001). CONCLUSION In geriatric patient with sigmoid volvulus, delayed surgical resection after decompression is associated with reduced cardiac complications and reduced ostomy rate, while increasing overall hospital length of stay and costs.
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Affiliation(s)
- Suzanne C Arnold
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Wardah Rafaqat
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - May Abiad
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Emanuele Lagazzi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Anne H Hoekman
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Vahe S Panossian
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Ikemsinachi C Nzenwa
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Charudutt N Paranjape
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
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Aksungur N, Peksoz R, Disci E, Atamanalp SS. Spontaneous decompression of sigmoid volvulus. Pak J Med Sci 2023; 39:1616-1619. [PMID: 37936730 PMCID: PMC10626113 DOI: 10.12669/pjms.39.6.8052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/18/2023] [Indexed: 11/09/2023] Open
Abstract
Objectives Spontaneous decompression is an uncommon outcome of sigmoid volvulus (SV). The aim of this study was to evaluate the clinical presentation, diagnosis, treatment, and follow-up of spontaneously decompressed SV. Methods We utilized the data of our 1,063 SV patients, the most comprehensive monocenter SV series in the world. To obtain the worldwide data on the spontaneous decompression of SV, we researched the last 56-years' literature in Web of Science and PubMed databases. Results The incidence of the spontaneous decompression was 0.1% (1/1,063) in our SV series, whereas it was 1.5% (8/549) in the worldwide data (Fisher exact test, p = 0.001). By this way, cumulative spontaneous decompression rate was found as 0.6% (9/1,602). In the spontaneously decompressed cases, the main clinical features were abdominal pain/tenderness, distention, and obstipation, which were similar to management-required patients. However, the treatment and follow-up algorithm is still a relatively undefined subject. Conclusion Spontaneous decompression of SV is a very rare clinical entity. The clinical presentation and diagnosis of the spontaneously decompressed SV look alike the management-required SV. However, as seen in most management-required patients, SV tends to recur in the spontaneously decompressed cases and a recurrence-reducing procedure is required in selected patients.
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Affiliation(s)
- Nurhak Aksungur
- Nurhak Aksungur, MD Assistant Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Rifat Peksoz
- Rifat Peksoz, MD Assistant Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Esra Disci
- Esra Disci, MD Associate Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Sabri Selcuk Atamanalp
- Sabri Selcuk Atamanalp, MD Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Pupulim LF, Stolz A. The split-wall sign. Abdom Radiol (NY) 2023; 48:3280-3281. [PMID: 37354263 DOI: 10.1007/s00261-023-03980-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Lawrence F Pupulim
- Department of Radiology, Réseau Hospitalier Neuchâtelois, Rue de la Maladière, 45, 2000, Neuchâtel, Switzerland.
| | - Alexandre Stolz
- Department of Radiology, Réseau Hospitalier Neuchâtelois, Rue de la Maladière, 45, 2000, Neuchâtel, Switzerland
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Nie X, Sha Y. Endoscopic decompression of sigmoid volvulus in an adolescent. Asian J Surg 2023; 46:4074-4076. [PMID: 37147257 DOI: 10.1016/j.asjsur.2023.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023] Open
Affiliation(s)
- Xin Nie
- Department of General Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 200437, China
| | - Yingying Sha
- Department of General Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 200437, China.
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Negm S, Farag A, Shafiq A, Moursi A, Abdelghani AA. Endoscopic management of acute sigmoid volvulus in high risk surgical elderly patients: a randomized controlled trial. Langenbecks Arch Surg 2023; 408:338. [PMID: 37635200 PMCID: PMC10460710 DOI: 10.1007/s00423-023-03071-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/15/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Most patients with sigmoid volvulus are of old age with multiple comorbidities. So, the risk of surgery for those elderly patients is usually associated with increased rates of morbidity and mortality. Early intervention is required for managing sigmoid volvulus to avoid its serious complications; therefore, early endoscopic untwist of sigmoid colon can be performed followed by endoscopic fixation of sigmoid colon under sedation in this category of the patients to avoid development of high risk surgical complications following surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy procedure to relieve obstruction. METHODS This prospective randomized controlled clinical trial included all patients who developed acute sigmoid volvulus and were referred to the Zagazig University Hospital Emergency Department between December 2020 and August 2022. The study was prospectively approved by Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9989/23-10-2022) and was retrospectively submitted in http://clinicaltrials.gov in November 2022 ( http://clinicaltrials.gov ID: NCT05620446). Included eligible patients were simply randomized at a 1:1 ratio to "Endoscopic Group (EG)" or "Surgical Group (SG)" via drawing of sealed envelopes containing computer-generated random numbers prepared by a third party before start of intervention. RESULTS Sample size included 18 patients divided into 2 equal groups. (1) Endoscopic group included 9 patients who were subjected to endoscopic untwist of sigmoid colon followed by endoscopic fixation of sigmoid colon under sedation; (2) Surgical group included 9 patients who were subjected to surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy under general anesthesia. In comparison between both groups, there were statistically significant differences regarding length of hospital stay and procedure time. Unfortunately, there were no statistically significant differences regarding postoperative complications and co-morbidities. Eight patients in the endoscopy group demonstrated excellent quality of life, and one demonstrated good quality of life; unlike the surgical group, there were 3 patients with excellent quality of life, 5 patients with good quality of life, and 1 patient with poor quality of life. So there was statistically significant difference regarding quality of life between both groups. During the 9-month follow-up period, both groups demonstrated no cases of recurrence post-fixation. CONCLUSION Endoscopic management of acute sigmoid volvulus is effective and safe in elderly high risk surgical patients (either in managing the intestinal obstruction caused by volvulus or in definitive treatment of volvulus).
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Affiliation(s)
- Said Negm
- Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Ahmed Farag
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Shafiq
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Adel Moursi
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Disci E, Peksoz R, Atamanalp SS. Sigmoid volvulus and diabetes mellitus. Pak J Med Sci 2023; 39:825-828. [PMID: 37250541 PMCID: PMC10214773 DOI: 10.12669/pjms.39.3.7309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/06/2023] [Accepted: 01/26/2023] [Indexed: 08/30/2023] Open
Abstract
Objectives Diabetes mellitus (DM) complicates about 15.7% of sigmoid volvulus (SV) cases. However, the pathophysiology of this relation is still unclear. Our objective was to evaluate the association of DM and SV. Methods The clinical data of 1,051 patients treated in Ataturk University Faculty of Medicine during 56 years between June 1966 and July 2022 were considered. The records of 612 cases (58.2%) were evaluated retrospectively till June 1986, while 439 (41.8%) were investigated prospectively thereafter. To obtain the worldwide data, an electronic search of the last 56-years' literature (from 1967 to date) was performed in Web of Science and PubMed databases. Results DM was statistically higher in SV patients than of general population (15.7% vs. 8.3%, p<0.001). Conversely, SV and DM co-occurrence was statistically lower in our series than of world-wide data (2.9% vs. 15.7%, p<0.001). In our series, SV and DM comorbidity was statistically higher in elders that that of children (3.9% vs. 0.0%, p<0.05). Although sigmoid gangrene was more common in DM patients when compared with that of total, the difference was not statistically significant (42.9% vs. 27.4%, p>0.05). Conversely, the mortality rate was statistically higher in DM cases than that of no diabetics in SV (28.6% vs. 7.8%, p<0.001). Conclusion Although the pathophysiology of SV and DM comorbidity is still relatively unexplainable, our study suggests that DM worsens the prognosis of SV. For this reason, early diagnosis and proper treatment have great importance in such patients.
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Affiliation(s)
- Esra Disci
- Esra Disci, MD, Associate Professor Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Rifat Peksoz
- Rifat Peksoz, MD, Assistant Professor Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Sabri Selcuk Atamanalp
- Prof. Sabri Selcuk Atamanalp, MD, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Senejoa N, González-Ausique PS, Enamorado-Enciso N. Sigmoid volvulus and descending colon adenocarcinoma, a double cause of intestinal obstruction: a case report. CIR CIR 2023; 91:839-843. [PMID: 38096878 DOI: 10.24875/ciru.22000179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/25/2022] [Indexed: 12/18/2023]
Abstract
Large bowel obstruction is caused by colorectal cancer, diverticular disease or volvulus. The latter is caused by rotation of the intestinal loop on its own mesenteric axis, and occurs in the sigmoid colon (80%) and in the cecum (15-20%) Its management includes devolution by colonoscopy or surgery. Malignant bowel obstruction is the initial presentation in 7-29% of colorectal cancer, and its optimal treatment is controversial. We describe a clinical case of a double obstructive lesion and its surgical approach, an unusual presentation that poses a diagnostic and medical-surgical management challenge.
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Affiliation(s)
- Nairo Senejoa
- Servicio de Coloproctología, Hospital Militar Central
| | | | - Nicolle Enamorado-Enciso
- Facultad de Medicina, Universidad Militar Nueva Granada, Hospital Militar Central. Bogotá, Colombia
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11
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Loria A, Jacobson T, Melucci AD, Bartell N, Nabozny MJ, Temple LK, Fleming FJ. Sigmoid volvulus: Evaluating identification strategies and contemporary multicenter outcomes. Am J Surg 2023; 225:191-197. [PMID: 35934559 DOI: 10.1016/j.amjsurg.2022.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is limited epidemiologic data on sigmoid volvulus (SV) from non-endemic regions. Therefore, we performed a multicenter study to report contemporary outcomes and appraise literature-based methods that pair diagnostic and procedural codes to identify SV. METHOD Using an automated search for patients with 'volvulus' in our system from 2011 to 2021, we reviewed electronic charts to clarify the diagnosis, automatically replicate three strategies to identify SV, and retrieved 6-month outcomes. RESULTS Of 895 patients, 109 had SV. Literature-based strategies poorly identified SV. At the index admission, patients underwent endoscopic reduction alone (33%), emergent (16.5%), semi-elective (34%), or elective (16.5%) surgery. Endoscopic reduction alone had high recurrence rates and delayed surgery was associated with worse outcomes. CONCLUSION Literature-based strategies to identify SV suffer from misclassification bias which affects patient counseling. In this large series, one-third of patients do not undergo during their index admission despite improved outcomes with earlier surgery.
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Affiliation(s)
- Anthony Loria
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA.
| | - Tricia Jacobson
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Alexa D Melucci
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Nicholas Bartell
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY, 146242, USA
| | - Michael J Nabozny
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Larissa K Temple
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Fergal J Fleming
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
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12
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Korkut E, Peksoz R, Disci E, Atamanalp SS. Factors affecting recurrence in sigmoid volvulus. Pak J Med Sci 2023; 39:150-153. [PMID: 36694777 PMCID: PMC9842996 DOI: 10.12669/pjms.39.1.6882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Recurrence is a relatively common outcome following endoscopic decompression in sigmoid volvulus (SV). This study aims to evaluate the factors affecting recurrence in SV. Methods In 434 patients with SV treated between June 1986 and January 2022, probable recurrence-affecting factors including age, age of SV onset, gender, dietary habit, defecation habit, altitude of living area, and SV attack count were analyzed in prospectively collected data. Results Of 434 patients, 111 (25.6%) had recurrent SV with mean 1.6 ± 2.3 of volvulus episodes (range: 1-21 attacks). SV recurrence demonstrated a significant linear increase with age (14.3%, 17.1%, 21.5%, and 29.9%, respectively, in young, middle aged, mature, and elderly patients, p < 0.001). Recurrent SV was also significantly higher in male gender (28.5% vs 12.7%, p = 0.004), high-fiber diet habit (32.9% vs 17.7%, p < 0.001), and living at high altitude (26.9% vs 12.5%, p = 0.047). Although SV recurrence was higher in patients with chronic constipation, the difference was not significant (36.7% vs. 20.3%, p = 0.594). When compared with that of the patients with mature onset or elderly onset patients, SV attack count was significantly higher in young-onset cases (1.3 ± 0.9 and 1.1 ± 0.3 vs 4.6 ± 6.9, p < 0.001). Conclusion Elderliness, early-onset, maleness, high-fiber diet habit, high altitude, and most likely chronic constipation may be the practical clinical parameters of recurrent SV. These parameters, as well as the presence of previous SV episode history, must be considered in the decision-making process in the elective treatment of SV.
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Affiliation(s)
- Ercan Korkut
- Ercan Korkut MD, Assistant Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Rifat Peksoz
- Rifat Peksoz MD, Assistant Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Esra Disci
- Esra Disci MD, Assistant Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Sabri Selcuk Atamanalp
- Sabri Selcuk Atamanalp MD, Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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13
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Kato H, Kinoshita H, Sakata Y. Acute abdominal pain due to sigmoid volvulus with persistent descending mesocolon: a case report. J Med Case Rep 2022; 16:349. [PMID: 36180925 DOI: 10.1186/s13256-022-03598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Persistent descending mesocolon, an anomaly of fixation of the mesentery of the descending colon, can sometimes cause complications such as intestinal obstruction and intussusception. We present the first reported case of sigmoid volvulus with persistent descending mesocolon. Case presentation An 82-year-old Japanese man had intermittent lower abdominal pain. Abdominal computed tomography showed dilation and a shift to the right side of the sigmoid colon, but no findings of volvulus. The next day, he presented continuous lower abdominal pain with bloody stool. A second abdominal computed tomography showed strangulation and dilation of the sigmoid colon, with shift from the right side of the abdominal cavity to the pelvic space. This suggested the descending colon was running to the medial side with sigmoid volvulus. Emergency surgery was performed for volvulus with persistent descending mesocolon. Operative findings revealed dilation of the sigmoid colon with a partial poorly colored region and strangulation that caused volvulus. After releasing the strangulation of the sigmoid colon, the descending colon was revealed to be running more to the medial side, with adherence to small intestinal mesentery. There was no Toldt’s fusion fascia at the descending colon. Persistent descending mesocolon was therefore diagnosed due to abnormality of fixation of the descending colon. The sigmoid colon, including the poorly colored region, was resected and reconstructed, while the inferior mesenteric and left colonic arteries were preserved because of the complexity of the vascular system running around the descending and sigmoid colon due to the shortened mesentery. These findings were pathologically compatible with circulatory compromise and intestinal degeneration due to sigmoid volvulus. The patient had no complications after discharge, including in relation to defecation. Conclusion Persistent descending mesocolon can occasionally cause acute abdominal symptoms requiring immediate treatment. A computed tomography finding of the descending colon running more to the medial side than ordinary cases can aid diagnosis of persistent descending mesocolon.
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14
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Slack Z, Shams M, Ahmad R, Ali R, Antunes D, Dey A, Patel M, Shabana A, Bond-Smith G, Tebala GD. Prognostic factors in the decision-making process for sigmoid volvulus: results of a single-centre retrospective cohort study. BMC Surg 2022; 22:95. [PMID: 35287640 PMCID: PMC8919604 DOI: 10.1186/s12893-022-01549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Sigmoid volvulus is a common cause of emergency surgical admission. Those patients are often treated conservatively with a high rate of recurrence. We wondered if a more aggressive management might be indicated.
Methods We have reviewed data of patients diagnosed with acute sigmoid volvulus over a 2-year period. The primary endpoint was patient survival.
Results We analysed 332 admissions of 78 patients. 39.7% underwent resection. Survival was 54.9 ± 8.8 months from the first hospitalization, irrespective of the treatment. Long-term survival was positively influenced by being female, having a low “social score”, a younger age and surgery. Multivariate analysis showed that only being female and surgery were independently associated with better survival.
Conclusion Early surgery may be the best approach in patients with recurrent sigmoid volvulus, as it ensures longer survival with a better quality of life, regardless of the patient’s social and functional condition.
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Affiliation(s)
- Zoe Slack
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Mohamed Shams
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Raheel Ahmad
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Roshneen Ali
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Diandra Antunes
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Abhishek Dey
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Mahul Patel
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Amanda Shabana
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Giles Bond-Smith
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Giovanni D Tebala
- Surgical Emergency Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
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15
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Abdelrahim A, Zeidan S, Qulaghassi M, Ali O, Boshnaq M. Dilemma of sigmoid volvulus management. Ann R Coll Surg Engl 2022; 104:95-99. [PMID: 35100844 DOI: 10.1308/rcsann.2021.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Patients with sigmoid volvulus (SV) are at a high risk of recurrence with increased morbidity and mortality. This study aims to review whether patients with SV underwent definitive surgical treatment after initial endoscopic reduction according to the guidelines, and to compare mortality rate between surgical and conservative management. METHODS Retrospective study conducted at East Kent Hospitals University NHS Foundation Trust, included all patients with SV between 2016 and 2018. The primary outcome was 30-day mortality following the initial management of the acute attack. Secondary outcomes were recurrence rate and overall mortality. The median follow-up period was 3 years. RESULTS A total of 40 patients were identified with a median age of 82 years; 27 (67%) were males. Of these 40 patients, 6 (15%) had emergency surgery, 26 (65%) received endoscopic decompression only, and 8 (20%) had planned definitive resection; 32 patients (80%) had recurrence and the median interval between any two episodes was 86 days. The mortality rate among patients with ASA grade 3 or 4 in the three groups, elective surgery, emergency surgery and decompression only, was 0%, 25% and 70% respectively, whereas it was 0%, 50% and 33% in those with ASA grade 2. The mortality rate among patients with similar ASA who had a planned surgery was significantly lower compared with those who did not undergo surgery (p=0.003). CONCLUSIONS In patients with sigmoid volvulus, regardless of ASA grade, performing early definitive surgery following initial endoscopic decompression resulted in a statistically significant lower mortality rate.
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Affiliation(s)
| | - S Zeidan
- Queen Elizabeth the Queen Mother Hospital, UK
| | | | - O Ali
- Queen Elizabeth the Queen Mother Hospital, UK
| | - M Boshnaq
- Queen Elizabeth the Queen Mother Hospital, UK
- Ain Shams University, Cairo, Egypt
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16
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García-Granados AR, Castañeda-Martínez LE. Synchronous volvulus of the cecum and sigmoid colon: a rare cause of intestinal obstruction. CIR CIR 2021; 89:4-8. [PMID: 34932538 DOI: 10.24875/ciru.21000044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 102-year-old female with a past medical history of sigmoid volvulus resolved by colonoscopy a year ago presents to the emergency department with sigmoid volvulus, which is resolved by colonoscopy and rectal tube placement. Three days later, she presented abdominal distention and recurrence of the volvulus, for which a surgical resolution was decided. Laparotomy was performed, where sigmoid and cecal volvulus was found. A cecal detorsion and a cecopexy were performed, and an extended left hemicolectomy with a terminal colostomy to treat the sigmoid volvulus. The patient presents an adequate postoperative period and is discharged. Three months later, the patient was in good clinical condition, eating normally without complications. Volvulus refers to the torsion of a segment of the gastrointestinal tract. The most common sites for colonic volvulus are sigmoid and cecum; however, it is infrequent for these to occur together. We only found six cases reported in the literature of synchronous volvulus of the cecum and sigmoid colon. None of the cases was the diagnosis made preoperatively, suggesting a difficult diagnosis. Treatment depends on the patient's condition; in most reported cases, a subtotal colectomy was performed. The prognosis depends on prompt surgical intervention.
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17
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Atamanalp SS, Disci E, Atamanalp CT, Atamanalp RS. Spontaneous Detorsion of Sigmoid Volvulus in a patient with Nineteen-Volvulus episode history: A rare outcome of an extremely rare clinical entity. Pak J Med Sci 2021; 37:2029-2031. [PMID: 34912439 PMCID: PMC8613068 DOI: 10.12669/pjms.37.7.4703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
Sigmoid volvulus (SV) recurrence more than 10 times is an extremely rare clinical entity and spontaneous detorsion is a rare outcome of SV. In this paper, we report a case with 19 previous SV attacks, in last of which spontaneous detorsion occurred. Such a multiple-episode history as well as an unexpected recovery was unique in a 1,036-case clinical profession of Ataturk University with SV over a 54.5-year period.
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Affiliation(s)
- Sabri Selcuk Atamanalp
- Prof. Sabri Selcuk Atamanalp, MD. Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Esra Disci
- Esra Disci, MD. Assistant Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Cansu Tatar Atamanalp
- Cansu Tatar Atamanalp, MD. Assistant, Department of Pediatrics, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Refik Selim Atamanalp
- Refik Selim Atamanalp, MD. Assistant, Department of Pathology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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18
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Abdelrahim A, Zeidan S, Qulaghassi M, Ali O, Boshnaq M. Dilemma of sigmoid volvulus management. Ann R Coll Surg Engl 2021; 104:95-99. [PMID: 34860119 DOI: 10.1308/rcsann.2021.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Patients with sigmoid volvulus (SV) are at a high risk of recurrence with increased morbidity and mortality. This study aims to review whether patients with SV underwent definitive surgical treatment after initial endoscopic reduction according to the guidelines, and to compare mortality rate between surgical and conservative management. METHODS Retrospective study conducted at East Kent Hospitals University NHS Foundation Trust, included all patients with SV between 2016 and 2018. The primary outcome was 30-day mortality following the initial management of the acute attack. Secondary outcomes were recurrence rate and overall mortality. The median follow-up period was 3 years. RESULTS A total of 40 patients were identified with a median age of 82 years; 27 (67%) were males. Of these 40 patients, 6 (15%) had emergency surgery, 26 (65%) received endoscopic decompression only, and 8 (20%) had planned definitive resection; 32 patients (80%) had recurrence and the median interval between any two episodes was 86 days. The mortality rate among patients with ASA grade 3 or 4 in the three groups, elective surgery, emergency surgery and decompression only, was 0%, 25% and 70% respectively, whereas it was 0%, 50% and 33% in those with ASA grade 2. The mortality rate among patients with similar ASA who had a planned surgery was significantly lower compared with those who did not undergo surgery (p=0.003). CONCLUSIONS In patients with sigmoid volvulus, regardless of ASA grade, performing early definitive surgery following initial endoscopic decompression resulted in a statistically significant lower mortality rate.
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Affiliation(s)
| | - S Zeidan
- Queen Elizabeth the Queen Mother Hospital, UK
| | | | - O Ali
- Queen Elizabeth the Queen Mother Hospital, UK
| | - M Boshnaq
- Queen Elizabeth the Queen Mother Hospital, UK.,Ain Shams University, Cairo, Egypt
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19
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Zain M, Abouheba M. Sigmoid volvulus; a rare complicated presentation of Hirschsprung's disease: A case report. Int J Surg Case Rep 2021; 89:106608. [PMID: 34808446 PMCID: PMC8607194 DOI: 10.1016/j.ijscr.2021.106608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/13/2021] [Accepted: 11/13/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Sigmoid volvulus (SV) is a rare complication of Hirschsprung's disease (HD) with only 31 cases have been reported in the English literature. Although its diagnosis is challenging, unrecognized SV is a life-threatening condition requiring early recognition to decrease morbidity and mortality. Presentation of case A 14-year-old male presented to our emergency department with massive abdominal distention. Plain erect abdominal X-ray showed massive colonic distention with multiple fluid levels. Colonoscopy failed to pass beyond 15 cm after entering dilated sigmoid loop. Open surgical exploration was done through a lower midline incision and revealed SV with massive distention of the entire colon. After detorsion, we found a markedly dilated sigmoid colon with an evident discrepancy at the lower sigmoid. Due to massive colonic dilatation, the decision was made for terminal ileostomy. Histopathological examination of biopsy from the narrow segment demonstrated aganglionosis and hypertrophic submucosal neural fibers confirming the diagnosis of HD. Discussion SV is a rare serious complication of HD. Unrecognized SV is a serious life-threatening condition, so it should be considered in children with acute or recurrent abdominal pain, distension, constipation and vomiting as early recognition and management of volvulus is essential to decrease morbidity. Conclusion The presented case highlights the possibility of SV as a rare complication of HD should be considered especially in children with a history of chronic constipation and abdominal distension who present with acute colonic distension and failure to decompress despite rectal washes. Sigmoid volvulus is a rare complication of Hirschsprung’s disease with a reported prevalence of 0.66%. Prompt diagnosis of the acute of volvulus decreases morbidity and increases survival. Sigmoid volvulus should be considered in children presenting with acute intestinal obstruction. In children with sigmoid volvulus, Hirschsprung’s disease should be suspected, and proper evaluation is required.
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Affiliation(s)
- Mostafa Zain
- Faculty of medicine, Alexandria university, Egypy.
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20
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Abstract
INTRODUCTION Sigmoid volvulus in pregnancy is a rare cause of intestinal obstruction with high maternal and fetal morbidity and mortality if not diagnosed and managed early. CASE PRESENTATION A 29-year-old female (Chagga by tribe) presented with clinical features of intestinal obstruction 24 weeks into her second pregnancy. She had symptoms for one week. An emergency laparotomy was performed whereby gangrenous sigmoid volvulus was found; thus, it was resected and Hartmann's colostomy was raised. Unfortunately, she experienced intrauterine fetal death post-operatively. She was discharged clinically stable. CONCLUSION Early diagnosis and management can prevent adverse effects such as bowel ischemia and preterm labor. Because classic clinical and radiological features may not be evident, high degree of suspicion is warranted.
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Affiliation(s)
- Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania. .,Kilimanja Christian Medical University College, P O Box 2240, Moshi, Tanzania.
| | - Joachim Magoma
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania
| | - Joylene Tendai
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania
| | - David Msuya
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania.,Kilimanja Christian Medical University College, P O Box 2240, Moshi, Tanzania
| | - Jamil Suleiman
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania
| | - Kondo Chilonga
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania.,Kilimanja Christian Medical University College, P O Box 2240, Moshi, Tanzania
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21
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Atamanalp SS. Comments on "Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?". GE Port J Gastroenterol 2021; 28:374-375. [PMID: 34604473 DOI: 10.1159/000512073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/25/2020] [Indexed: 11/19/2022]
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22
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Ahmadinejad M, Ahmadinejad I, Soltanian A, Mardasi KG, Taherzade N. Using new technicque in sigmoid volvulus surgery in patients affected by COVID19. Ann Med Surg (Lond) 2021; 70:102789. [PMID: 34512969 PMCID: PMC8416359 DOI: 10.1016/j.amsu.2021.102789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Coronavirus pandemic-initiated Wuhan city, Hubei Province, China. It mainly involves respiratory system and cause fever, cough. However, it has other manifestations such as GI system, CNS and skin involvement. It is transmitted mostly through respiratory system, but some researchers claim that in can potentially spread by oral, fecal or intestinal gas. During colorectal surgeries such as volvulus sigmoid, surgeons are at risk of exposure to intestinal gas. CASE PRESENTATION A 57-year-old mentally retarded man came to our emergency department with complain of abdominal pain, constipation, obstipation, nausea, vomiting and abdominal distention. His vital sign was stable and his laboratory data revealed no abnormality. His abdominal x-ray showed intestinal obstruction with suspicious of sigmoid volvulus. His PCR for COVID 19 was positive and his chest CT scan has manifestations of lung involvement. He was proceeded for surgery. CONCLUSION Owing to odds of spread of coronavirus through intestinal gas, in this case, sigmoid colon was removed without evacuation of intestinal gas.
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Affiliation(s)
- Mojtaba Ahmadinejad
- Department of Surgery, School of Medicine, Shahid Madani Hostpital, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Ali Soltanian
- Department of Surgery, School of Medicine, Shahid Madani Hostpital, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Noshin Taherzade
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
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Tankel J, Gilshtein H, Neymark M, Zuckerman M, Spira R, Yellinek S. Sigmoidectomy following sigmoid volvulus: who is at risk of anastomotic failure? Tech Coloproctol 2021; 25:1225-31. [PMID: 34480672 DOI: 10.1007/s10151-021-02508-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Anastomotic leak following elective sigmoidectomy performed due to sigmoid volvulus (SV) is a devastating complication. The aim of this study was to identify the incidence and risk factors associated with leak in this specific group of patients. METHODS A retrospective study was performed at two university-affiliated tertiary centres in Israel. All consecutive patients between January 2014 and April 2020 treated for SV with elective sigmoidectomy and primary anastomosis were reviewed and those suffering from anastomotic leak identified. Factors associated with this complication were assessed using univariate analysis and odds ratios subsequently calculated. RESULTS Of the 99 patients initially identified, 58 were included in the study group [45 males and 13 females (77.6% versus 22.4% respectively) mean age 67.4 years, range 13-97]. There were 10 anastomotic leaks identified (17.2%). On univariate analysis recurrent decompression (OR 8.28, p = 0.027), age > 80-years (OR 6.88, p = 0.027), open rather than laparoscopic surgery (OR = 5.83, p = 0.005) and ASA grade 3/4 (OR 0.132, p = 0.023) were significantly associated with anastomotic leak. Male sex approached but not reach statistical significance. CONCLUSIONS Recurrent endoscopic decompression, age > 80 years, open surgery and ASA grade 3/4 are associated with anastomotic leak and these patients should be considered for formation of a colostomy instead. If an anastomosis is performed, patients should be appropriately counselled and monitored in the perioperative period.
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Mongold S, Inman B, Long B, Cibrario A, Bridwell RE. Sigmoid volvulus after trauma, an uncommon twist: A case report. Am J Emerg Med 2021; 52:269.e3-269.e5. [PMID: 34511286 DOI: 10.1016/j.ajem.2021.08.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 12/13/2022] Open
Abstract
Sigmoid volvulus occurs when a portion of sigmoid colon twists around its blood supply at the base of the mesentery, causing ischemia and necrosis. In developed nations, this is most commonly a condition of elderly, bed-bound, chronically constipated individuals. However, this condition may occur after blunt abdominal trauma, especially in individuals with underlying anatomic derangements from the aforementioned conditions. We present a unique case of sigmoid volvulus in a patient with no pre-existing abdominal complaints or surgical history, who sustained blunt traumatic injuries when she was struck by a motor vehicle. Prompt recognition of this deadly condition by emergency clinicians facilitated rapid surgical correction and mitigated further morbidity and mortality.
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Affiliation(s)
- Sarah Mongold
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Brannon Inman
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
| | - Brit Long
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
| | - Amber Cibrario
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
| | - Rachel E Bridwell
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
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25
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Hardy NP, McEntee PD, McCormick PH, Mehigan BJ, Larkin JO. Sigmoid volvulus: definitive surgery is safe and should be considered in all instances. Ir J Med Sci 2021; 191:1291-1295. [PMID: 34327621 PMCID: PMC9135785 DOI: 10.1007/s11845-021-02713-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
Background Acute sigmoid volvulus (ASV) represents a small but significant portion of cases of large bowel obstruction, especially in the elderly and co-morbid. Given the characteristics of the patient cohort most commonly affected, a non-operative/conservative approach is often undertaken but is associated with a high rate of recurrence. Objective We sought to evaluate outcomes for those patients who underwent non-operative management, emergency surgery or staged, semi-elective surgery following decompression for ASV at our institution. Methods Hospital in-patient enquiry (HIPE) data were used to identify all patients who presented with sigmoid volvulus between January 2005 and June 2020 inclusive. Patient notes were interrogated, including surgical and endoscopic procedures performed. Patient demographics and co-morbidities were recorded. Results Thirty-nine patients were treated over a 15-year period with a mean age of 73 years at first presentation (range 36–93). Twenty-two patients (56%) had just a single admission for ASV with three deaths in this group. Seventeen patients (44%) had more than one admission with volvulus due to recurrence after a decompression-only strategy on the index admission. Of these, three succumbed to complications of their subsequent episodes of volvulus. Twenty-five patients underwent surgical intervention (fifteen on, or shortly following, their first admission and ten following at least two admissions for ASV). The overall mortality in the operative group was 2/25 (8%) with both deaths in those undergoing emergency surgeries. Five patients were treated successfully with endoscopic measures alone and had required no further interventions at the time of compiling data. Conclusion There is a high recurrence rate following non-operative management of acute sigmoid volvulus and consequently, a cumulative increase in the attendant significant morbidity and mortality with subsequent episodes. Given the relatively low complication rate of definitive surgery, even in those patients perceived to be high risk, we contend that all patients should be considered for early surgery to prevent the likely recurrence of sigmoid volvulus.
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Affiliation(s)
- Niall P Hardy
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - Philip D McEntee
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - Paul H McCormick
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - Brian J Mehigan
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - John O Larkin
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland.
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Horvat M, Hazabent M, Sekej M, Kljaić Dujić M. Pediatric sigmoid volvulus of an extremely long sigmoid colon with hypoganglionosis: a case report. J Int Med Res 2021; 49:3000605211032429. [PMID: 34311600 PMCID: PMC8320571 DOI: 10.1177/03000605211032429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sigmoid volvulus is an extremely rare cause of intestinal obstruction in pediatric patients. This condition occurs when a redundant sigmoid loop with a narrow mesenteric base of attachment to the posterior abdominal wall rotates around its mesenteric axis. This situation might result in vascular occlusion and large bowel obstruction. There are only a few predisposing factors of sigmoid volvulus, such as a long-term history of constipation or pseudo-obstruction with an excessive sigmoid colon. Underlying hypoganglionosis can also lead to large bowel obstruction. There have only been two reported cases of hypoganglionosis with sigmoid volvulus, and both were in adults. Sigmoid volvulus usually presents with abdominal pain, nausea, vomiting, constipation and abdominal distension, an absence of stool, or the presence of melenic stool in the rectum. Initial treatment options are non-surgical for stable patients, although surgical management might be necessary. If sigmoid volvulus is not recognized and resolved, it may lead to serious complications and death. Pediatric sigmoid volvulus is frequently the fulminant type, and therefore, a decision about treatment must be prompt. We present an unusual pediatric case of an extremely long sigmoid colon with hypoganglionosis, which twisted and caused obstruction. This condition was resolved with surgical resection.
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Affiliation(s)
- Matjaž Horvat
- University Medical Centre Maribor, Maribor, Slovenia
| | | | - Marjan Sekej
- University Medical Centre Maribor, Maribor, Slovenia
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Visalli C, Trimarchi R, Spatola A, Miano SM, Salamone I. Non-invasive treatment of the sigmoid volvulus. A pediatric case report. Radiol Case Rep 2021; 16:2429-2433. [PMID: 34257774 PMCID: PMC8260760 DOI: 10.1016/j.radcr.2021.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
Sigmoid volvulus occurs when the sigmoid colic loop gets wrapped around its own mesocolon. While this condition is categorized as an extremely rare emergency in the pediatric population, diagnosis is often difficult due to the fact that its aspecific manifestations or sneaky symptoms are similar to other medical conditions. The available treatment options remain controversial up to this day, and the non-operative approach is more preferred in treating hemodynamic stable patients. This paper examines the case study of a 13-year-old girl suffering from sigmoid volvulus, who was treated with water-soluble contrast enema, in order to determine whether this method is efficient and effective in successfully treating the pathology of this condition.
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Surek A, Akarsu C, Gemici E, Ferahman S, Dural AC, Bozkurt MA, Donmez T, Karabulut M, Alis H. Risk factors affecting failure of colonoscopic detorsion for sigmoid colon volvulus: a single center experience. Int J Colorectal Dis 2021; 36:1221-1229. [PMID: 33512567 DOI: 10.1007/s00384-021-03864-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Colonoscopic detorsion (CD) is the first treatment option for uncomplicated sigmoid volvulus (SV). We aim to examine the factors affecting the failure of CD. METHODS The files of patients, treated after diagnosis of SV between January 2015 and September 2020, were retrospectively reviewed. Patients' demographic data, comorbidities, endoscopy reports, and surgical and other treatments were recorded. Patients were divided into two groups, as the successful CD group and unsuccessful CD group. The data were compared between the groups, and multivariate analysis of statistically significant variables was performed. RESULTS There were 21 patients in the unsuccessful CD group and 52 patients in the successful CD group. The unsuccessful CD rate was found to be 28.76%; this is likely a function of more neuropsychiatric disease, more accompanying sigmoid diverticulum, previous abdominal surgery, abdominal tenderness, onset of symptoms for more than 48 h, higher mean intra-abdominal pressure (IAP), IAP over 15 mmHg, larger mean diameter of the cecum, the cecum diameter over 10 cm, and higher mean C-reactive protein (CRP) values as statistically significant. In the multivariate analysis, previous abdominal surgery and cecum diameter over 10 cm were seen as predictive factors for failure of CD (p=0.049, OR=0.103, and p = 0.028, OR=10.540, respectively). CONCLUSIONS CD failure rate was significantly associated with previous abdominal surgery and a cecum diameter over 10 cm. We found that patients with these factors will tend to need more emergency surgery.
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Affiliation(s)
- Ahmet Surek
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey.
| | - Cevher Akarsu
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Eyup Gemici
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Sina Ferahman
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Cem Dural
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Abdussamet Bozkurt
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Turgut Donmez
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Karabulut
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Halil Alis
- Department of Surgery, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
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Emna T, Atef M, Sarra S. Management of acute sigmoid volvulus: A tunisian experience. Asian J Surg 2021; 45:148-153. [PMID: 33895046 DOI: 10.1016/j.asjsur.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND/OBJECTIVE Sigmoid volvulus is the most common type of volvulus. Its epidemiological features, as well as its management, differ between developed and developing countries. This work aims to analyze the epidemiological features thus allowing to compare them to the rest of the "volvulus belt'' and assess the surgical management of sigmoid volvulus in Tunisia. METHOD This is a retrospective review of 64 patients with sigmoid volvulus treated in the General Surgery department of Jendouba Hospital. January 2005-December 2019. RESULTS 64 patients were treated for acute sigmoid volvulus. The sex ratio male to female ratio was 5.4/1 with male predominance. 5.4:1 (54 males to 10 females). The mean age was 62 years. The classic triad of intestinal occlusion was reported in 56 patients. The mean duration of symptoms was 4.2 days. An accurate preoperative diagnosis was made in 58 cases. Forty patients had a viable bowel obstruction, and all of them had a resection and primary anastomosis. Sixteen patients had a gangrenous bowel obstruction, of which 6 patients had resection-primary anastomosis, and 10 had Hartmann's procedure. Out of the total five deaths reported, there were only two among patients who had resection-primary anastomosis for gangrenous bowel obstruction. The most common postoperative complication was wound infections in 5 cases. The median length of hospital stay following surgery was 8 days. No recurrences of volvulus after a median follow-up of 11 months. CONCLUSIONS Although Tunisia belongs to the volvulus belt, the epidemiologic features of sigmoid volvulus tend rather be similar to those of developed countries. The use of primary surgery, if no endoscopy is performed, is a good alternative. For patients who have contraindications for endoscopic treatment, surgical treatment is the only option.
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Affiliation(s)
- Trigui Emna
- Department of General Surgery, Jendouba Hospital, Tunisia; Tunis El Manar University, Tunisia.
| | - Mejri Atef
- Department of General Surgery, Jendouba Hospital, Tunisia; Tunis El Manar University, Tunisia
| | - Saad Sarra
- Department of General Surgery, Jendouba Hospital, Tunisia; Tunis El Manar University, Tunisia
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Kusunoki R, Fujishiro H, Miyake T, Suemitsu S, Kataoka M, Fujiwara A, Tsukano K, Kotani S, Yamanouchi S, Aimi M, Tanaka M, Miyaoka Y, Kohge N, Imaoka T, Yuasa K, Kodama K, Ishihara S, Kinoshita Y. Initial Computed Tomography Findings of Long and Distended Colon Are Risk Factors for the Recurrence of Sigmoid Volvulus. Dig Dis Sci 2021; 66:1162-1167. [PMID: 32409950 DOI: 10.1007/s10620-020-06317-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 05/02/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Sigmoid volvulus is a common condition in elderly patients with elongated colons. Although endoscopic de-torsion is effective as the primary treatment of sigmoid volvulus, elective surgery is recommended because of the high risk of recurrence and high mortality rate. AIM The aim of this study was to determine the risk factors for the recurrence of sigmoid volvulus. METHODS Clinical records of patients treated at Shimane Prefectural Central Hospital were reviewed retrospectively. Among 41 sigmoid volvulus patients who were successfully treated by endoscopic de-torsion and followed up, 30 were observed over 1 year. Among the 30 patients, eight (26.7%) did not experience recurrence, while 22 (73.3%) did. Initial computed tomography (CT) findings indicating the sigmoid colon extending to the diaphragm or ventral to the liver were defined as "extension findings." Extension findings and sigmoid diameter were evaluated in relation to sigmoid volvulus recurrence. RESULTS Extension findings were significantly more frequent in the recurrent group (77.3%) than in the nonrecurrent group (25.0%) (P = 0.009). Distended sigmoid colon diameter was significantly larger in the recurrent group (11.7 ± 3.8 cm) than in the nonrecurrent group (7.1 ± 1.1 cm) (P = 0.044). Receiver operating characteristic curve analysis demonstrated that the performance threshold was greater than 8.9 cm. Kaplan-Meier analysis showed the significantly high sigmoid volvulus recurrence rate in the patients with extension findings and a distended sigmoid colon greater than 8.9 cm. CONCLUSIONS CT findings of a long and distended sigmoid colon in initial sigmoid volvulus are risk factors for the recurrence of sigmoid volvulus.
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Affiliation(s)
- Ryusaku Kusunoki
- Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
| | - Hirofumi Fujishiro
- Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Tatsuya Miyake
- Department of Hepatology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Shinsuke Suemitsu
- Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Masatoshi Kataoka
- Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Aya Fujiwara
- Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Kosuke Tsukano
- Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Satoshi Kotani
- Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Satoshi Yamanouchi
- Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Masahito Aimi
- Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Masaki Tanaka
- Department of Endoscopy, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Youichi Miyaoka
- Department of Endoscopy, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Naruaki Kohge
- Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Tomonori Imaoka
- Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Kouji Yuasa
- Department of Radiology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Kouji Kodama
- Department of Radiology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Shunji Ishihara
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
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Ibrahim H, Sabra TA, Maher A. Short bowel syndrome as a result of sigmoid volvulus in an 8-year-old child. The first reported case worldwide: A case report. Int J Surg Case Rep 2021; 81:105769. [PMID: 33820736 PMCID: PMC8073200 DOI: 10.1016/j.ijscr.2021.105769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION We present a case of a male child 8 years old presenting with a sigmoid volvulus causing ischemia of most of bowel loops resulting in a short bowel syndrome. It is the first reported case worldwide. PRESENTATION A male child presented with a picture of intestinal obstruction. After complete laboratory and radiological investigation, laparotomy was done revealing a sigmoid volvulus compessing most of the small bowel loops with gangrenous sigmoid colon for which sigmoidectomy with end colostomy, resection of gangrenous small bowel loops and primary anastomosis of the remaining healthy part. DISCUSSION There are few reported cases describing sigmoid volvulus in this age group. However, none of them resulted in short bowel syndrome. The median age was 7 years with a higher ratio in males than females (3.5:1). CONCLUSION Sigmoid volvulus is not a common problem in children and adolescents, and is rarely considered as a cause of intestinal obstruction and it was never reported as a cause of short bowel syndrome. Early diagnosis and prompt treatment confer an excellent prognosis.
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Affiliation(s)
- Hussein Ibrahim
- Pediatric Surgery Unit, Assiut University Children Hospital, Assiut, Egypt.
| | | | - Ahmed Maher
- Pediatric Surgery Unit, Assiut University Children Hospital, Assiut, Egypt
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32
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Hamdy O, Yousry M, Saleh GA. An infarcted wandering spleen leading to a sigmoid volvulus presenting with acute large bowel obstruction: a case report. Ann R Coll Surg Engl 2021; 103:e127-e130. [PMID: 33682463 DOI: 10.1308/rcsann.2020.7144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A wandering spleen is a very rare event characterised by the absence of the spleen in its anatomical position due to the hyperlaxity of its ligaments. We present a case of wandering spleen complicated by splenic vascular pedicle torsion, thrombosis and subsequent splenic infarction. Compression of the infarcted spleen on the rectosigmoid junction led to the development of a sigmoid volvulus, which presented as an acute large bowel obstruction. The patient underwent emergency laparotomy, splenectomy, sigmoid decompression and sigmoidopexy. After a follow-up period of two years, the volvulus had not recurred.
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Affiliation(s)
- O Hamdy
- Mansoura University, Mansoura, Egypt
| | - M Yousry
- Mansoura University, Mansoura, Egypt
| | - G A Saleh
- Mansoura University, Mansoura, Egypt
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33
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Gosaye AW, Nane TS, Negussie TM. A case report of Hirschsprung's disease presenting as sigmoid volvulus and literature review, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. BMC Surg 2021; 21:109. [PMID: 33657993 PMCID: PMC7931363 DOI: 10.1186/s12893-020-00938-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Sigmoid volvulus is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group. A high index of suspicion is necessary to reach a diagnosis and avoid morbidity and mortality. Sigmoid volvulus is a rare complication of Hirschsprung’s disease, which has been reported in neonates, children, and adults. Here we report a case of sigmoid volvulus accompanied by undiagnosed Hirschsprung's disease. Case presentation A 9 years old boy who presented with sudden onset of colicky abdominal pain of 4 h duration associated with gross abdominal distension and 2 episodes of non-bilious vomiting. A plain abdominal radiographs showed single hugely dilated bowel loops in the left lower quadrant with single air fluid level. Sigmoid volvulus was considered and rectal tube deflation was done and it was successful. Full thickness rectal biopsy was done and it was consistent with aganglionic megacolon. A primary trans-anal Soave endo-rectal pull through was done 3 weeks later, after biopsy result arrived, which yielded loss of symptoms and regular bowel movement. Conclusions Sigmoid volvulus should be considered in the differential for children presenting with acute onset of abdominal obstruction. It should be known that when its’s diagnosed in children, it is often associated with Hirschsprung's disease. Therefore, a proper diagnostic and treatment algorithm should be followed in order not to miss associated HD and to give optimum care to such patients.
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Affiliation(s)
- Abay Wondimu Gosaye
- Department of Surgery, Tikur Anbessa Specialized Hospital, Addis Ababa University, Zambia St., Addis Ababa, Ethiopia.
| | - Temesgen Setato Nane
- Department of Surgery, Tikur Anbessa Specialized Hospital, Addis Ababa University, Zambia St., Addis Ababa, Ethiopia
| | - Tihitena Mammo Negussie
- Department of Surgery, Tikur Anbessa Specialized Hospital, Addis Ababa University, Zambia St., Addis Ababa, Ethiopia
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Surek A, Akarsu C, Gemici E, Ferahman S, Dural AC, Bozkurt MA, Donmez T, Karabulut M, Alis H. Risk factors affecting failure of colonoscopic detorsion for sigmoid colon volvulus: a single center experience. Int J Colorectal Dis 2021. [PMID: 33512567 DOI: 10.1007/s00384-021-03864-3.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Colonoscopic detorsion (CD) is the first treatment option for uncomplicated sigmoid volvulus (SV). We aim to examine the factors affecting the failure of CD. METHODS The files of patients, treated after diagnosis of SV between January 2015 and September 2020, were retrospectively reviewed. Patients' demographic data, comorbidities, endoscopy reports, and surgical and other treatments were recorded. Patients were divided into two groups, as the successful CD group and unsuccessful CD group. The data were compared between the groups, and multivariate analysis of statistically significant variables was performed. RESULTS There were 21 patients in the unsuccessful CD group and 52 patients in the successful CD group. The unsuccessful CD rate was found to be 28.76%; this is likely a function of more neuropsychiatric disease, more accompanying sigmoid diverticulum, previous abdominal surgery, abdominal tenderness, onset of symptoms for more than 48 h, higher mean intra-abdominal pressure (IAP), IAP over 15 mmHg, larger mean diameter of the cecum, the cecum diameter over 10 cm, and higher mean C-reactive protein (CRP) values as statistically significant. In the multivariate analysis, previous abdominal surgery and cecum diameter over 10 cm were seen as predictive factors for failure of CD (p=0.049, OR=0.103, and p = 0.028, OR=10.540, respectively). CONCLUSIONS CD failure rate was significantly associated with previous abdominal surgery and a cecum diameter over 10 cm. We found that patients with these factors will tend to need more emergency surgery.
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Affiliation(s)
- Ahmet Surek
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey.
| | - Cevher Akarsu
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Eyup Gemici
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Sina Ferahman
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Cem Dural
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Abdussamet Bozkurt
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Turgut Donmez
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Karabulut
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Halil Alis
- Department of Surgery, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
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Kazem Shahmoradi M, Khoshdani Farahani P, Sharifian M. Evaluating outcomes of primary anastomosis versus Hartmann's procedure in sigmoid volvulus: A retrospective-cohort study. Ann Med Surg (Lond) 2021; 62:160-163. [PMID: 33520215 PMCID: PMC7820798 DOI: 10.1016/j.amsu.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study is to compare the short outcomes of two methods of sigmoid resection and primary anastomosis with sigmoid resection and end colostomy (Hartmann's procedure) for sigmoid volvulus. Methods This retrospective study included 102, of which 56 patients underwent end colostomy (Hartmann's procedure) and 46 patients underwent resection and primary anastomosis for sigmoid volvulus. The medical records of the patients were reviewed to evaluate the patients' characteristics, operative data, short-term postoperative outcomes and mortality. Results The mean age of patients in the groups of Hartmann's procedure and primary anastomosis were 68.23 ± 13.42 and 70.10 ± 12.71, respectively. From the 46 patients who had primary colorectal anastomosis, 2 patients (4.3%) suffered from anastomosis leakage, which was not significantly different. This study showed that anastomosis leakage, prolonged ileus, bleeding, surgical site infection and fascial dehiscence were not different between Hartmann's procedure and primary anastomosis, significantly, p < 0.05. Hospital stay in the Hartmann group was less than primary anastomosis group in the same admission, p = 0.04. The mortality rate was not statistically different among the two groups, p = 0.549. Conclusions Postoperative complications and mortality rate do not different among the two groups however, the duration of hospitalization was lesser in Hartmann's procedure group.
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Affiliation(s)
- Mohammad Kazem Shahmoradi
- Department of General Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Parham Khoshdani Farahani
- Department of General Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Masoud Sharifian
- Department of General Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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36
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Lee K, Oh HK, Cho JR, Kim M, Kim DW, Kang SB, Kim HJ, Park HC, Shin R, Heo SC, Ryoo SB, Park KJ. Surgical Management of Sigmoid Volvulus: A Multicenter Observational Study. Ann Coloproctol 2020; 36:403-408. [PMID: 33486909 PMCID: PMC7837394 DOI: 10.3393/ac.2020.03.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/23/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose This study aimed to evaluate real-world clinical outcomes from surgically treated patients for sigmoid volvulus. Methods Five tertiary centers participated in this retrospective study with data collected from October 2003 through September 2018, including demographic information, preoperative clinical data, and information on laparoscopic/open and elective/emergency procedures. Outcome measurements included operation time, postoperative hospitalization, and postoperative morbidity. Results Among 74 patients, sigmoidectomy was the most common procedure (n = 46), followed by Hartmann’s procedure (n = 23), and subtotal colectomy (n = 5). Emergency surgery was performed in 35 cases (47.3%). Of the 35 emergency patients, 34 cases (97.1%) underwent open surgery, and a stoma was established for 26 patients (74.3%). Elective surgery was performed in 39 cases (52.7%), including 21 open procedures (53.8%), and 18 laparoscopic surgeries (46.2%). Median laparoscopic operation time was 180 minutes, while median open surgery time was 130 minutes (P < 0.001). Median postoperative hospitalization was 11 days for laparoscopy and 12 days for open surgery. There were 20 postoperative complications (27.0%), and all were resolved with conservative management. Emergency surgery cases had a higher complication rate than elective surgery cases (40.0% vs. 15.4%, P = 0.034). Conclusion Relative to elective surgery, emergency surgery had a higher rate of postoperative complications, open surgery, and stoma formation. As such, elective laparoscopic surgery after successful sigmoidoscopic decompression may be the optimal clinical option.
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Affiliation(s)
- Keunchul Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Rae Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Minhyun Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyung-Jin Kim
- Department of Surgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyoung-Chul Park
- Department of Colorectal Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Rumi Shin
- Department of Surgery, Seoul Metropolitan GovernmentSeoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Chul Heo
- Department of Surgery, Seoul Metropolitan GovernmentSeoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Esmat HA. Sigmoid volvulus in a teenager, successfully managed with endoscopic detorsion: An unusual case report and review of the literature. Int J Surg Case Rep 2020; 77:875-879. [PMID: 33395915 PMCID: PMC7732972 DOI: 10.1016/j.ijscr.2020.11.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/29/2020] [Indexed: 11/26/2022] Open
Abstract
Sigmoid volvulus is an uncommon cause of bowel obstruction in children and teenagers. Early diagnosis and timely definitive treatment can prevent complications. Endoscopic detorsion is the initial treatment of choice in sigmoid volvulus in the absence of complications. Elective surgery with sigmoid resection and primary anastomosis is mandatory to prevent a recurrence.
Introduction Sigmoid volvulus (SV) occurs due to torsion of a dilated sigmoid colon around its mesenteric axis. This causes venous and arterial blood flow obstruction with progressive bowel ischemia, necrosis, and perforation if left untreated. In pediatric surgical practice volvulus of the sigmoid colon remains a rare occurrence and only a few isolated case reports and case series have been reported. The author presents herein a case of SV in a 19-year-old male. Case report A 19-year-old male was presented to the emergency service of our hospital complaining of abdominal pain, constipation, nausea, and vomiting for 4 days. Radiologic imaging showed the features of the sigmoid volvulus. Endoscopic detorsion was applied and the patient underwent elective surgery for anterior sigmoid resection to prevent the recurrence. Discussion Sigmoid volvulus, first described by von Rokitansky in 1836 and remains a major cause of colonic intestinal obstruction in adults, which results from twisting of the sigmoid colon on its mesentery. The median age in children at presentation is 7 years, ranging from 4 h to 18 years. Conclusion Sigmoid volvulus is an uncommon cause of bowel obstruction in teenagers and should be included in the differential diagnosis of young patients present with abdominal pain and absolute constipation. Early diagnosis and timely definitive treatment can prevent complications. Endoscopic detorsion is the initial treatment of choice in the absence of complications. However, elective surgery with sigmoid resection and primary anastomosis is mandatory to prevent a recurrence.
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Affiliation(s)
- Habib Ahmad Esmat
- Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan; Fellow of Radiology at EGE University Hospital, Izmir, Turkey.
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Dholoo F, Shabana A, See A, Hameed W. Case-report: A rare cause of intestinal obstruction in late pregnancy. Int J Surg Case Rep 2020; 80:105391. [PMID: 33431333 PMCID: PMC7982489 DOI: 10.1016/j.ijscr.2020.11.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022] Open
Abstract
Caecal volvulus represents a rare and often life-threatening cause of intestinal obstruction, with associated high mortality rates. Diagnosis and early intervention remain a challenge, as patients may only present with vague nonspecific symptoms. More classical symptoms of volvulus eventually occur, usually secondary to obstruction or ischaemia. Early diagnosis and intervention are of paramount importance. We advise clinicians to remember this diagnosis, as a potential cause of abdominal pain and obstruction; especially in those with risk factors.
Introduction Caecal volvulus represents a rare and often life-threatening cause of intestinal obstruction. Diagnosis and management of caecal volvulus remains a clinical challenge, since those presenting with symptoms can have vague nonspecific presentations. Symptoms eventually occur, usually secondary to obstruction or ischaemia. This case report will discuss the presentation, investigation and management options available. Presentation A 31-year-old multigravida, at 38 weeks and 6 days gestation; presented to hospital with a 2-day history of diffuse abdominal pain and distension. Initial examination was unremarkable aside from mild epigastric tenderness. Raised inflammatory markers and concerns for foetal health resulted in an emergency caesarean section. Symptoms however worsened and the patient underwent colonoscopy and computerised tomography (CT) of the abdomen and pelvis with contrast; showing caecal volvulus. The patient was taken to the operating theatres for an emergency right hemicolectomy with formation of end ileostomy. Intra-operatively, areas of necrosis were noted within the caecum suggestive of impending perforation. The patient recovered well post reversal of end ileostomy, with no complications to date. Discussion Caecal volvulus represents a rare, but potentially fatal cause of intestinal obstruction and ischaemia. High mortality rates are attributed to delayed diagnosis and treatment. Patients may initially present with vague symptoms, which rapidly progress with the development of ischaemia. Multiple management modalities exist. Central to prognosis is early diagnosis. Conclusion Early diagnosis and intervention are paramount. Imaging via abdominal x-rays and CT are of particular importance. Surgical management is widely reported as the mainstay of treatment. We advise clinicians to remember this rare diagnosis, as a potential cause of abdominal pain and intestinal obstruction; especially in those with predisposing risk factors.
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Affiliation(s)
- Farzan Dholoo
- Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, General Surgery Department, Reading, UK.
| | - Amanda Shabana
- John Radcliffe Hospital, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Abbas See
- John Radcliffe Hospital, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Waseem Hameed
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, General Surgery, Berkshire, UK
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Assenza M, Ciccarone F, Iannone I, Bracchetti G, De Meis E, Santillo S, Ballanti Storace C, Mazzarella G, De Cicco ML. Elective Treatment of Large-Bowel Obstruction in Asymptomatic Sigmoid Volvulus. Clin Ter 2020; 171:e466-e470. [PMID: 33151242 DOI: 10.7417/ct.2020.2258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sigmoid volvulus is an uncommon cause of intestinal obstruction representing the 5% of all Western cases, associated with old age and a history of neurological and psychiatric condition. Generally, its diagnosis is established by clinical and radiologic findings. It often represents an emergency and it is commonly associated with pain, vomit and abdominal tenderness. CASE PRESENTATION We present a case of a 59 years old man, admitted to our emergency department, showing an abdominal X-Ray reporting a distention of large bowel,which was required due to presence of multiple diarrhea episodes during the previous 7 days. He had no significant past medical history and did not report constipation or subocclusive episode. CONCLUSIONS Volvulus should be considered in the differential diagnosis in adult and healthy patients with bowel obstructions. Surgery is, in all cases, the radical and definitive treatment since there is a higher mortality in case of recurrent volvulus. Despite the massive bowel distention, our choice was the elective open surgery. Primary anastomosis is feasible and safe and did not lead to any complications. In case of unsuccessful colonic decompression, evidence to support or refute the safety and effectiveness of laparoscopic surgical resection for treatment of patients with sigmoid volvulus disease is not yet proven.
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Affiliation(s)
- M Assenza
- Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
| | - F Ciccarone
- Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
| | - I Iannone
- Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
| | - G Bracchetti
- Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
| | - E De Meis
- Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
| | - S Santillo
- Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
| | - C Ballanti Storace
- Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
| | - G Mazzarella
- Surgical First Aid Unit, Department of Emergency Surgery, Sapienza University of Rome, Rome
| | - M L De Cicco
- Radiology Department of Emergency Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Abstract
INTRODUCTION The aim of this systematic review was to appraise the current literature on the use of percutaneous endoscopic colostomy (PEC) as an alternative to major surgery and endoscopic decompression alone for treating sigmoid volvulus in frail, comorbid patients. METHODS A systematic literature search of literature published between April 2000 and January 2017 was carried out using the MEDLINE®, Embase™ and CINAHL® (Cumulative Index to Nursing and Allied Health Literature) databases. The search terms were "percutaneous endoscopic colostomy", "PEC", "sigmoidopexy", "sigmoidostomy" and "sigmoid volvulus". The studies identified were screened and those that did not fulfil the inclusion criteria were excluded. FINDINGS Seven observational studies and seven case reports (comprising eighty-one patients) were found to match our inclusion criteria. All patients had recurrent sigmoid volvulus and were treated with PEC either with a single PEC tube or with two PEC tubes inserted. Sigmoid volvulus recurred in 10 of the 81 patients; 3 of these individuals developed recurrence with PEC tubes in situ and 7 following tube removal. There were seven deaths after the procedure. The most frequent morbidity associated with PEC tube insertion was site infection (n=6). CONCLUSIONS Our systematic review highlights the use of PEC as an alternative in managing recurrent sigmoid volvulus in frail, comorbid patients unfit for or refusing surgery, with the best outcomes seen in those patients where two PEC tubes were inserted and remained in situ indefinitely. Further studies are needed to improve the safety and efficacy of the procedure as well as post-procedure care.
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Affiliation(s)
- S Jackson
- University Hospitals Bristol NHS Foundation Trust, UK
| | - MO Hamed
- Norfolk and Norwich University Hospitals NHS Foundation Trust, UK
| | - J Shabbir
- University Hospitals Bristol NHS Foundation Trust, UK,CORRESPONDENCE TO Jamshed Shabbir, E:
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Kim EM, Kang BM, Kim BC, Kim JY, Park JH, Oh BY, Kim JW. Clinical outcomes of sigmoid volvulus and risk factors for its recurrence: a multicenter study in Korea. Int J Colorectal Dis 2020; 35:1841-1847. [PMID: 32072227 DOI: 10.1007/s00384-020-03526-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Sigmoid volvulus is one of the leading causes of colonic obstruction. The aims of this study were to review the treatment characteristics and clinical outcomes of patients diagnosed with sigmoid volvulus over 10 years at five university-affiliated hospitals in Korea, and to identify possible risk factors for its recurrence. METHODS Retrospective review was performed for medical records of patients who were diagnosed with sigmoid volvulus and managed surgically or conservatively at the five Hallym University-affiliated hospitals between January 2005 and July 2018. RESULTS A total of 69 patients were diagnosed, of whom 11 patients underwent emergency surgery and 58 patients were conservatively managed. Non-operative management was successful in 53 of 58 patients (91.4%) at initial admission. Of the non-operative managed patients, six patients required emergency surgery due to unsuccessful decompression or recurrence whereas 23 patients underwent regular surgery for definitive treatment. And overall recurrence rate and mortality rate were 25.8% (15/58) and 1.7% (1/58), respectively. A total of 40 patients underwent surgery; 23 underwent regular surgery and 17 underwent emergency surgery. Restoration of bowel continuity was more frequently performed in the regular surgery group than in the emergency surgery group (87.0% vs 52.9%, P = 0.03). In multivariable analysis, only non-operative management at the initial admission (P = 0.029) was independently associated with recurrence. CONCLUSION Although non-operative treatment can be initially attempted, surgery is required for preventing recurrence. Regular surgery should be considered to restore continuity of the bowel.
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Affiliation(s)
- Eui Myung Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Sukwoo-Dong, Hwaseong-Si, Gyeonggi-Do, 445-170, Republic of Korea
| | - Byung Mo Kang
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon- Si, 200-950, Republic of Korea
| | - Byung Chun Kim
- Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, 1, Shingil-ro, Yeongdeungpo-gu, Seoul, 150-950, Republic of Korea
| | - Jeong Yeon Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Sukwoo-Dong, Hwaseong-Si, Gyeonggi-Do, 445-170, Republic of Korea
| | - Jun Ho Park
- Department of Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 445 Gil-1-dong, Gangdong-gu, Seoul, 134-701, Republic of Korea
| | - Bo Young Oh
- Department of Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang-Si, 445-907, Republic of Korea
| | - Jong Wan Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Sukwoo-Dong, Hwaseong-Si, Gyeonggi-Do, 445-170, Republic of Korea.
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Yasuda K, Oura S, Kashu N, Yoshitake H, Takami T, Shintani H, Kataoka N, Yamaguchi T, Makimoto S. Sigmoid Volvulus with Widespread Bowel Ischemia after Endoscopic Reduction Successfully Treated with Elective Laparoscopic Surgery. Case Rep Gastroenterol 2020; 14:286-290. [PMID: 32518540 PMCID: PMC7265717 DOI: 10.1159/000507611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/30/2020] [Indexed: 11/25/2022] Open
Abstract
An 87-year-old man complaining of abdominal distention was referred to our hospital. Plain radiograph and enhanced computed tomography (CT) showed a dilated sigmoid colon with a coffee bean sign, leading to the diagnosis of sigmoid volvulus. Based on symptoms and the CT and laboratory test findings, we initially treated the patient with endoscopic reduction, resulting in successful reduction of the sigmoid volvulus with widespread presumed mucosal ischemia. Due both to the lack of emerging symptoms suggesting colon perforation and to the laboratory test findings after endoscopic reduction, we treated the patient without further urgent surgical intervention. Two months later, the patient underwent successful elective laparoscopic surgery with a redundant sigmoid colon resection and a functional end-to-end anastomosis. He has been well without any events for 20 months. Conservative treatment with careful observation should be taken into consideration in the treatment of sigmoid volvulus with mild to moderate ischemia after endoscopic reduction.
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Affiliation(s)
- Koji Yasuda
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Shoji Oura
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Nozomi Kashu
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | | | - Tomoya Takami
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Hiroshi Shintani
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Naoki Kataoka
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
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Abstract
Purpose Colonic volvulus constitutes a significant cause of large bowel obstruction in adults. Most studies of colonic volvulus come from high endemic zones and are limited by the small number of patients. In our region, there is a shortage of studies concerning this disorder, and treatment of colonic volvulus remains controversial. Methods This is a retrospective study of 34 patients who presented with colonic volvulus at a single academic institution in a 4-year period and their respective treatment and outcomes. Results A total of 34 patients, 17 males (50%) and 17 females (50%), with a mean age of 55 ± 23.9 years underwent treatment for colonic volvulus. Twelve patients (35.3%) underwent initial decompression, followed by a Hartman procedure in 4 patients (11.7%) and sigmoid resection with primary anastomosis in 3 patients (8.8%), with 3 fatalities (8.8%) following initial decompression. Two patients (5.8%) were lost to follow-up. Twenty-two patients (64.7%) underwent emergency surgery, of whom 16 (47%) underwent a Hartman procedure, with colorectal anastomosis in 9 patients (26.4%), with 3 fatalities (8.8%) immediately after the first procedure. Four patients (11.7%) were lost to follow up after the Hartman procedure. Of the 6 remaining patients (17.6%), of the emergency surgical group, 3 patients (8.8%) had an initial sigmoidectomy and primary anastomosis, and the remaining 3 patients (8.8%) had a cecal volvulus with a right hemicolectomy performed with primary anastomosis in 2 patients (5.8%) and with a fatality in the remaining patient, on whom a terminal ileostomy was performed for damage control. The mean hospital stay was 5.7 days, with an overall mortality rate of 23.5%. Conclusion Acute colonic volvulus in our region is not as uncommon as in other parts of the world. This disorder must be suspected when a patient presents with abdominal pain, abdominal distension, and bean sign on plain X-rays and/or a whirl sign on computed tomography scan.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.,Hospital Metropolitano "Dr. Bernardo Sepúlveda," Secretaria de Salud de Nuevo León, San Nicolás de los Garza, México
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.,Hospital Metropolitano "Dr. Bernardo Sepúlveda," Secretaria de Salud de Nuevo León, San Nicolás de los Garza, México
| | - Gerardo Gil-Galindo
- Hospital Metropolitano "Dr. Bernardo Sepúlveda," Secretaria de Salud de Nuevo León, San Nicolás de los Garza, México
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Abstract
Exposure and infections by Trypanosoma cruzi are the fourth cause of loss of potential life years between parasitic and infectious diseases. We describe the case of a 11-year-old patient with intestinal occlusion, surgically treated with intestinal volvulus, the surgical specimen is sent to histopathology reporting Chagasic megacolon. The age range of presentation is a challenge in the absence of nonspecific symptoms. There is no pediatric statistical data that define trypanosomiasis in a latent or chronic state and will be diagnosed in adult stages due to the physiopathological alterations that they will present.
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Affiliation(s)
- Víctor H García-Orozco
- Servicio de Cirugía General. Hospital Civil de Tepic Dr. Antonio González Guevara, Servicios de Salud de Nayarit, Tepic, Nayarit, México
| | - Daniel García-Sánchez
- Servicio de Cirugía Pediátrica. Hospital Civil de Tepic Dr. Antonio González Guevara, Servicios de Salud de Nayarit, Tepic, Nayarit, México
| | - Juan F López-Flores
- Banco de Leche Humana. Hospital Civil de Tepic Dr. Antonio González Guevara, Servicios de Salud de Nayarit, Tepic, Nayarit, México
| | - Ricardo Sánchez-Mata
- Servicio de Cirugía General. Hospital Civil de Tepic Dr. Antonio González Guevara, Servicios de Salud de Nayarit, Tepic, Nayarit, México
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Mulugeta GA, Awlachew S. Retrospective study on pattern and outcome of management of sigmoid volvulus at district hospital in Ethiopia. BMC Surg 2019; 19:107. [PMID: 31399131 PMCID: PMC6688328 DOI: 10.1186/s12893-019-0561-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 07/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Sigmoid volvulus is the commonest cause of large bowel obstruction in many regions of the world. Its prevalence varies greatly geographically. In Ethiopia, the disease is the commonest cause of emergency admissions due to intestinal obstruction. However, few studies have been conducted discussing the management outcome in Ethiopia and Africa. This research was conducted to assess the pattern & management outcome of acute sigmoid volvulus at a district hospital in South-west Ethiopia. Methods A facility based retrospective cross-sectional review of surgical records was done to identify patients who had acute sigmoid volvulus. Data was collected using structured questionnaire by three pre trained data collectors. The collected data was checked for its completeness, and then entered, edited, cleaned and analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0. For all statistical significance tests the cut-off value set was P < 0.05. Result A total of 131 patients were managed for acute sigmoid volvulus. 108 (82.4%) were men with a male to female ratio of 4.7:1. The hospital prevalence of acute sigmoid volvulus was 27.9%. Majority (42%) of the patients were in the 6th decades of life. Abdominal pain, abdominal distention & inability to pass feces & flatus were the predominant presenting compliant while abdominal distention was the dominant physical finding in all of the patients. Ninety-seven patients (74%) had viable bowel obstruction of which 29 patients had successful rectal tube deflation. The remaining 68 patients were managed operatively by either primary resection & anastomosis (62 patients) or derotation alone (6 patients). Thirty-four patients had gangrenous bowel obstruction and were managed by either primary resection and anastomosis (16 patients) or Hartman’s colostomy (18 patients). Six patients died of which 5 had primary resection and anastomosis (2 for viable and 3 for gangrenous bowel obstruction).The predominant postoperative complication was wound infection in 11(10.7%) patients. Factors associated with unfavorable outcome were female sex, primary resection & end to end anastomosis and presentation of illness more than 24 h. Conclusion The most common management was primary resection and anastomosis. The overall mortality rate was 4.5% and the mortality rate related to primary resection and end to end anastomosis was 6.4%. Mortality rate was higher in those patients who had resection and anastomosis for gangrenous bowel compared to those who had viable bowel (19% vs 3%). Generally factors associated with poor outcome were duration of illness, primary resection and anastomosis and being female.
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Bhandari TR, Shahi S. Volvulus of sigmoid colon in a challenged adolescent: An unusual case report. Ann Med Surg (Lond) 2019; 44:26-28. [PMID: 31297192 PMCID: PMC6598602 DOI: 10.1016/j.amsu.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 12/29/2022] Open
Abstract
Sigmoid volvulus is very uncommon cause of intestinal obstruction in pediatrics population withhigh rate of mortality. To date, few cases of sigmoid volvulus in children and association with several condition has been reported in literature, of them very few cases are with mental disability. We report a challenged (mentally disabled) 14-year old adolescent boy presented asan emergency with feature of complete bowel obstruction. Abdominal X-rays shows dilated loop of large bowel with inverted U shaped. Volvulus of sigmoid colon was found during laparotomy and successfully managed with resection of a redundant colon with colocolic end to end anastomosis. Sigmoid volvulus is relatively uncommon in children as compared to adults. Surgeons should be attentive of this rare entity, cause of large bowel obstruction to allow for early diagnosis and to enable better patient outcomes by reducing the morbidity and mortality.
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Affiliation(s)
- Tika Ram Bhandari
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal.,Formerly Department of General Surgery, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Sudha Shahi
- Department of ENT Head and Neck Surgery, National Academy of Medical Sciences, Kathmandu, Nepal
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Eldirdiri S, Musa IH, Adam HY, Suliman AG, Ata Elmanan MM, Eldirdiri S, O M Awadelseed Y, O A Bakhiet M. Transverse colonic volvulus after resection of sigmoid volvulus: Presentation of a case report. Int J Surg Case Rep 2019; 60:257-260. [PMID: 31255937 PMCID: PMC6606923 DOI: 10.1016/j.ijscr.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/25/2019] [Accepted: 06/07/2019] [Indexed: 12/04/2022] Open
Abstract
Volvulus is a common cause of large bowel obstruction but its metachronous occurrence is an extreme rarity. Metachronous transverse colonic volvulus should be eliminated as a differential diagnosis. Gangrenous bowel is a life threatening condition and should be dealt with as an emergency situation with the adequate procedure. The elective surgical resection should follow optimization of the general condition and set-up.
Introduction Colonic volvulus is the third leading cause of colonic obstruction in the world following colorectal cancer and complicated sigmoid diverticulitis. Transverse colon is the rarest among other colonic volvulus. Moreover synchronous/metachronous transverse colonic volvulus is extremely rare condition with only few case reported in the literature, we hereby report this case of metachronous transverse colonic volvulus years after sigmoidectomy for sigmoid volvulus Case presentation A case of transverse colon volvulus in elderly male with history of chronic constipation and a previous history of a sigmoid volvulus resection few years ago. He presented as an emergency with typical features of acute large bowel obstruction. He was successfully managed with a good out come Discussion We discuss the presentation, diagnosis and surgical management with a literature review of this case of a metachronous transverse colonic volvulus. Conclusion Metachronous colonic volvulus is an extremely rare cause of large bowel obstruction and should be considered as a differential diagnosis especially in geographic areas with high rate of volvulus or in those with underlying risk factor
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Affiliation(s)
| | | | - Hawa Y Adam
- Sudan Medical Specialization Board, Khartoum Sudan
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Abstract
The increasing number of refugees, migrants and international travelers influences the surgical spectrum of abdominal diseases. The aim of this review is to familiarize surgeons with specific diseases which are endemic in the patients' countries of origin and are likely to be diagnosed with increasing incidence in Germany. Low levels of hygiene in the countries of origin or refugee camps is associated with a high incidence of numerous infections, such as helminth infections, typhoid fever or amoebiasis, which if untreated can cause surgical emergencies. Historically, some of them were common in Germany but have been more or less eradicated because of the high socioeconomic standard. Echinococcosis and Chagas disease are frequently treated surgically while schistosomiasis can mimic intestinal cancer. Abdominal tuberculosis presents in a variety of abdominal pathologies and frequently causes diagnostic uncertainty. Sigmoid volvulus has a very low incidence among Europeans, but is one of the most common abdominal surgical conditions of adults in endemic countries. The number of patients who eventually undergo surgery for these conditions might be relatively low; however, surgeons must be aware of them and consider them as differential diagnoses in refugees and migrants with acute or chronic abdominal symptoms.
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Affiliation(s)
- T J Wilhelm
- Chirurgische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - S Post
- Chirurgische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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Yuksel ME, Ozberk O, Ozkan N. Whirl sign in sigmoid volvulus. J Visc Surg 2019; 156:277-278. [PMID: 31076342 DOI: 10.1016/j.jviscsurg.2019.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M E Yuksel
- Aksaray University School of Medicine, Department of General Surgery, Aksaray, Turkey.
| | - O Ozberk
- Aksaray University Training and Research Hospital, Department of Radiology, Aksaray, Turkey
| | - N Ozkan
- Aksaray University School of Medicine, Department of General Surgery, Aksaray, Turkey
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Quénéhervé L, Dagouat C, Le Rhun M, Perez-Cuadrado Robles E, Duchalais E, Bruley des Varannes S, Touchefeu Y, Chapelle N, Coron E. Outcomes of first-line endoscopic management for patients with sigmoid volvulus. Dig Liver Dis 2019; 51:386-390. [PMID: 30377062 DOI: 10.1016/j.dld.2018.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/27/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery. AIM The aim of this study was to compare death rate between elective sigmoidectomy and conservative management following endoscopic detorsion for sigmoid volvulus. METHODS The medical records of 83 patients undergoing endoscopic detorsion of a sigmoid volvulus from 2008 to 2014 were retrospectively reviewed. Patients were divided into two groups: 'elective surgery' and 'no surgery'. RESULTS Patients in the 'no surgery' group (n = 42) were older and had more loss of autonomy than in the 'elective surgery' group. Volvulus endoscopic detorsion was successful in 96% of patients with no complications. The median follow-up was 13 months (1 day-67 months). The death rate was 62% in the 'no surgery' group versus 32% in the 'elective surgery' group (p = 0.02). In the 'no surgery' group, 23/42 of patients had volvulus recurrence. No recurrence occurred after surgery. CONCLUSION Elective surgery must be planned as soon as possible after the first episode of sigmoid volvulus. In frail patients, other options must be developed.
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Affiliation(s)
- Lucille Quénéhervé
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France.
| | - Caroline Dagouat
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | - Marianne Le Rhun
- Clinical Gerontology Department, University Hospital of Nantes, France
| | | | - Emilie Duchalais
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | | | - Yann Touchefeu
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | - Nicolas Chapelle
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | - Emmanuel Coron
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
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