Trends in the Evaluation and Treatment of Patients Presenting With Sigmoid Volvulus Over the Past 15 Years

Few studies have assessed changes over time in the evaluation and treatment of patients presenting with acute sigmoid volvulus. We sought to evaluate trends in sigmoid volvulus care at a single center between 2010 and 2024. We hypothesized that there would be increasing rates in the use of computed tomography (CT) scans, lactate levels, laparoscopic surgery, and same-admission surgery.

A single-center, retrospective study was performed for all adult admissions for acute sigmoid volvulus over 15 years (2010-2024). Each admission was assessed individually for demographic, clinical, laboratory, radiographic, endoscopic, and surgical data. As each admission was assessed separately and was the unit of analysis, some patients could contribute multiple episodes to the study. Outcomes were compared between three five-year periods (2010-2014, 2015-2019, 2020-2024).

One hundred and eighty-four episodes of sigmoid volvulus from 103 unique patients were included (median age 77.0 [IQR 66.2-83.0], 76.6% male). CT scan use increased from 17.6% to 25.7% to 47.6% (p=0.001 groups 1 vs 3; p=0.009 groups 2 vs 3; p trend <0.001). While the rate in which lactate was checked did not significantly change over time (p trend 0.634), the rate in which C-reactive protein (CRP) was assessed increased from 29.4% to 75.7% to 92.1% (p<0.001 for groups 1 vs 2; p<0.001 for groups 1 vs 3; p=0.011 for groups 2 vs 3; p trend <0.001). The rates of same-admission surgery (13.7% to 21.7% to 23.8% of all cases; p trend=0.193) and laparoscopic surgery (0% to 13.3% to 20.0% of all same-admission surgeries; p trend=0.219) trended upwards but were not statistically significant. Patient outcomes, including mortality (p trend=0.747), did not significantly change during the study period.

CT scans and CRP are increasingly being used, while surgical trends are progressing more slowly in the management of sigmoid volvulus patients, although these changes have not been associated with detectable changes in outcomes. Limited power and confounding may obscure small effects and have limited our findings. Larger, multi-center studies may help to better elucidate these trends.