Optimizing management of sigmoid volvulus: predictors of surgical intervention and early recurrence

Sigmoid volvulus is a life-threatening condition requiring urgent intervention. Endoscopic detorsion is the preferred initial treatment; however, delayed surgical management in emergent cases may increase complications and mortality. Additionally, early recurrence following successful detorsion remains a significant challenge. This study aims to identify predictors of emergency surgery and early recurrence in patients with sigmoid volvulus.

A retrospective analysis was conducted on patients with sigmoid volvulus treated between January 2015 and January 2025. Patients were stratified based on the need for emergency surgery. Demographic data, clinical presentation, laboratory parameters, radiologic findings, and treatment modalities were analyzed. The primary outcomes were the need for emergency surgery and recurrence, while short-term postoperative outcomes were assessed as secondary outcome.

A total of 62 patients were included, with a median age of 77 years. Emergency surgery was required in 34 patients (53.2%). Higher C-reactive protein and lactate levels were associated with emergency surgery. The presence of ischemia on CT or colonoscopy, increased transverse colon diameter, a longer distance from the vascular origin to the obstructed bowel segment, and volvulus rotation ≥ 360° were significant predictors of emergency surgical intervention. Multivariate analysis confirmed all predictors except lactate level and transverse colon diameter. Emergency surgery resulted in higher complication and ostomy rates compared to elective surgery following successful detorsion. Recurrence occurred in 13 patients (44.8%), but no significant predictors were identified. However, ostomy rates were higher in the recurrence group without an associated increase in complications.

Predictors of emergency surgery in sigmoid volvulus include a longer distance from the vascular origin to the obstructed segment, ischemia on imaging, elevated CRP levels, and volvulus rotation ≥ 360°. Early recognition of these factors may facilitate timely surgical decision-making and improve patient outcomes. Further studies are needed to assess recurrence predictors and optimize management strategies.