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Multiplex attacks in sigmoid volvulus.

Esra Disci1, Rifat Peksoz2, Enes Agirman3

  • 1Esra Disci, MD. Associate Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Pakistan Journal of Medical Sciences
|July 2, 2024
PubMed
Summary

Multiplex sigmoid volvulus (SV) attacks are rare but associated with significantly higher recurrence and mortality. Elective surgery may be considered for selected patients experiencing multiple SV attacks to prevent severe outcomes.

Keywords:
Multiple attacksMultiplex attacksSigmoid volvulus

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Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology
  • Colorectal Surgery

Background:

  • Sigmoid volvulus (SV) is a condition where the sigmoid colon twists on its mesentery.
  • Recurrence rates for SV are significant, affecting about a quarter of patients.
  • Multiplex attacks (three or more episodes) are exceptionally rare but carry a higher risk.

Purpose of the Study:

  • To investigate the incidence and characteristics of multiplex sigmoid volvulus attacks.
  • To compare findings from a single-center series with global data on SV recurrence and multiplex attacks.
  • To evaluate the prognosis and mortality associated with single, double, and multiplex SV attacks.

Main Methods:

  • A retrospective and prospective analysis of 1,071 sigmoid volvulus cases was conducted.
  • Data collected included patient demographics, history of previous attacks, and outcomes.
  • Worldwide data on sigmoid volvulus were retrieved from the Web of Science database for comparative analysis.

Main Results:

  • The mean SV attack count was 1.4 in the series and 1.7 in worldwide data.
  • Multiple (≥2) and multiplex (≥3) attack rates were 26.1% and 4.2% in the series, versus 26.7% and 3.2% globally.
  • Recurrence rates increased with attack count (26.1% for single, 19.3% for double, 51.2% for multiplex), as did mortality (7.3%, 13.7%, 19.5% respectively).

Conclusions:

  • Multiplex sigmoid volvulus attacks are infrequent but associated with substantially increased recurrence and mortality rates.
  • The findings highlight the need for careful consideration of surgical intervention in selected patients with recurrent or multiplex SV.
  • Proactive management, including elective surgery, may be crucial to mitigate the risks of repeated episodes and associated complications.