Relationship Between Sigmoid Volvulus Subtypes, Clinical Course, and Imaging Findings

Area of Science:

• Gastroenterology
• Radiology
• Surgical Pathology

Background:

• Sigmoid volvulus (SV) is a common cause of large bowel obstruction.
• Recent research suggests the organo-axial subtype is more prevalent than the mesentero-axial subtype.
• Distinguishing between SV subtypes is crucial for effective management.

Purpose of the Study:

• To identify clinical and radiological differences between organo-axial and mesentero-axial sigmoid volvulus.
• To evaluate treatment outcomes and prognostic factors for each subtype.
• To determine the utility of computed tomography (CT) in differentiating SV subtypes.

Main Methods:

• Retrospective review of 54 patients with sigmoid volvulus.
• Analysis of abdominal plain radiographs and CT scans by two radiologists.
• Documentation of recurrence, mortality, and treatment outcomes.

Main Results:

• The mesentero-axial subtype was more common (74% of cases).
• No radiographic findings reliably differentiated the subtypes.
• CT revealed the number of transition zones as a key differentiator.
• The diameter of the volvulus segment was larger in the mesentero-axial subtype.
• Endoscopic detorsion failed in five patients with mesentero-axial SV.

Conclusions:

• CT imaging is essential for differentiating sigmoid volvulus subtypes.
• Accurate subtype identification impacts prognosis and therapeutic strategies.
• Understanding these differences aids in optimizing patient care for sigmoid volvulus.