The sigmoid volvulus: surgical timing and mortality for different clinical types

Area of Science:

• Gastroenterology
• Surgical Oncology

Background:

• Sigmoid volvulus is a rare cause of intestinal obstruction in Western countries, associated with significant mortality, particularly with delayed diagnosis.
• Understanding optimal surgical timing and its impact on prognosis for different clinical presentations is essential.

Purpose of the Study:

• To evaluate the impact of surgical timing on patient prognosis in sigmoid volvulus.
• To determine the best surgical approach based on clinical presentation and disease stage.

Main Methods:

• Retrospective clinical study of 23 patients treated for sigmoid volvulus between January 1996 and January 2009.
• Patients were categorized into two groups: those with clear signs of obstruction and those with subocclusive symptoms.
• Analysis focused on 30-day postoperative mortality in relation to surgical timing and procedure.

Main Results:

• In the obstruction group, mortality was 44%, primarily in patients with peritonitis undergoing sigmoid resection (57%). No deaths occurred with intestinal derotation and colopexy.
• In the subocclusive group, mortality was 35%, increasing to 50% with late diagnosis and sigmoid resection.

Conclusions:

• Patient mortality in sigmoid volvulus is linked to disease stage, surgical timing, and patient factors.
• Prompt surgical intervention is critical; mortality is elevated in obstructed patients with peritonitis and subocclusive patients with late diagnosis.
• Hartmann's procedure is indicated for obstructed patients with generalized peritonitis and subocclusive patients with late diagnosis and surgical treatment.