The relationship between clinical features and treatment options in sigmoid volvulus: Experience of 59 years and 1,096 patients

TL;DR

This study examines which clinical features indicate the need for emergency surgery in patients with sigmoid volvulus, based on data from over 1,000 patients.

Contribution

The study identifies specific clinical indicators that predict the need for emergency surgery in sigmoid volvulus cases.

Findings

Nonoperative detorsion was more common in patients without a history of volvulus and with shorter symptom duration.

Gangrenous stool and rebound tenderness/muscular rigidity were absolute indicators for emergency surgery.

Hyperkinetic bowel sound and empty rectum were more common in patients treated nonoperatively.

Abstract

In sigmoid volvulus (SV), nonoperative detorsion is the first treatment option, while some complicated patients require emergency surgery. The purpose of this study was to utilize the clinical features requiring emergency surgery in SV.

Among total 1,096 patients with SV, the records of 813 cases (74.2%) treated with nonoperative detorsion and 492 patients (44.9%) required emergency surgery were evaluated in a partial retrospective and prospective scanning.

Previous volvulus history was more common (34.7% vs. 26.2%, respectively, p<0.005), mean symptom period was shorter (23.9 hours vs. 47.5 hours, respectively, p<0.001), the rates of vomiting (62.7% vs. 75.2%, respectively, p<0.001), hypokinetic/akinetic bowel sound (37.3% vs. 48.0%, respectively, p<0.001) and shock (1.3% vs. 22.2%, respectively, p<0.001) were lower, while the rates of hyperkinetic bowel sound (35.3% vs. 20.1%, respectively, p<0.001) and empty rectum (67.9% vs. 60.2%, respectively, p<0.05) were higher in nonoperative detorsion group when compared with that of emergency surgery group. The rates of pregnancy (5.4% vs. 5.6%, respectively, p>0.05), comorbidity (31.7% vs 29.1%, respectively, p>0.05), abdominal pain/tenderness (98.9% vs. 99.0%, respectively, p>0.05), distention (97.2% vs. 98.4%, respectively, p>0.05) and obstipation/constipation (92.9% vs. 94.7%, respectively, p>0.05) were similar in both groups. All patients with gangrenous stool (19.5%) and rebound tenderness/muscular rigidity (16.5%) required emergency surgery.

Some preoperational parameters including first attack, prolonged preoperative period, vomiting, hypokinetic/akinetic bowel sound and shock may be relative indicators, while gangrenous stool and rebound tenderness/muscular rigidity are absolute indications of emergency surgery in SV.

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