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Management of sigmoid volvulus: is early surgery justifiable?

AbstractINTRODUCTION:
Sigmoid volvulus typically occurs in older patients who have multiple co-morbidities. Therefore, often, a conservative approach to management is chosen. However, there is little data on long-term outcomes of this approach in Australasia. The aim of this study was to review the recurrence and mortality outcomes of patients admitted to Dunedin Hospital with sigmoid volvulus.
METHODS:
All cases of sigmoid volvulus admitted to the Department of General Surgery at Dunedin Hospital from January 1989 to January 2009 were identified using a prospective database, the Otago Clinical Audit. Mortality data was accessed from the National Births and Deaths Registry.
RESULTS:
Fifty-seven patients, median age of 68, were included in the study with 84 admissions for sigmoid volvulus. A total of 39 of the 57 patients ultimately had surgery, 26 on the index admission. Thirty-one patients (61%) treated conservatively at index admission had a recurrence at a median of 31 days. Forty-two per cent of the patients treated conservatively a second time suffered a further recurrence at a median of 144 days. There was no recurrence in patients who had surgery. There was no in-hospital mortality reported in either group. There was one anastomotic leak in the surgical group. Minor complications included ileus, respiratory infections, urinary tract infection and a hernia.
CONCLUSION:
Early elective operation for cases of sigmoid volvulus is encouraged in patients without prohibitive co-morbidities as this study shows a high recurrence rate in conservatively managed patients and a low morbidity and mortality in surgically managed patients.
AuthorsOmid Yassaie, Mark Thompson-Fawcett, Jeremy Rossaak
JournalANZ journal of surgery (ANZ J Surg) Vol. 83 Issue 1-2 Pg. 74-8 (Jan 2013) ISSN: 1445-2197 [Electronic] Australia
PMID22924840 (Publication Type: Evaluation Study, Journal Article)
Copyright© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.
Topics
  • Aged
  • Colectomy
  • Elective Surgical Procedures
  • Female
  • Humans
  • Intestinal Volvulus (mortality, surgery, therapy)
  • Kaplan-Meier Estimate
  • Length of Stay (statistics & numerical data)
  • Male
  • Patient Readmission (statistics & numerical data)
  • Postoperative Complications
  • Recurrence
  • Sigmoid Diseases (mortality, surgery, therapy)
  • Sigmoidoscopy
  • Treatment Outcome

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