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Sigmoid volvulus: diagnosis in 938 patients over 45.5 years

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Abstract

Background

Sigmoid volvulus (SV) is the wrapping of the sigmoid colon around itself and its mesentery. The goal of this study was to investigate the diagnosis approach to 938 patients with SV treated at our institution and their clinical outcomes.

Methods

The clinical records of 938 patients with SV treated at our institution between June 1966 and January 2012 were retrospectively reviewed.

Results

The mean age was 58.6 years (range 10 weeks to 98 years), and 774 patients (82.5 %) were male. A total of 210 (25.1 %) of 837 patients, who provided information on anamnesis and clinical features, had recurrent episodes of volvulus; 215 patients (25.7 %) had comorbidities, and 108 patients (12.9 %) presented with toxic or hypovolemic shock. The mean duration of symptoms was 38.7 h (range 6 h to 7 days), and the most common clinical features were abdominal pain and tenderness (827 of 837 patients, 98.8 %), distention (805 patients, 96.2 %), and obstipation (771 patients, 92.1 %). The final diagnosis was made with endoscopy in 519 patients (55.3 %), endoscopy followed by surgery in 154 patients (16.4 %) and at surgery in 265 patients (28.3 %). The correct diagnosis rate was 71.6 % based on clinical findings compared with 66.7 % based on plain X-ray films, 81.4 % based on both clinical and plain X-ray findings, and 100.0 % based on CT or MRI findings.

Conclusions

Sigmoid volvulus is common in adult men. The disease is generally associated with recurrent episodes, comorbidity, and shock. SV generally presents as a large-bowel obstruction. Although plain X-rays may help with diagnosis, CT and MRI are more reliable diagnostic tools, and flexible endoscopy is always diagnostic. However, surgery is used to diagnose SV in limited situations.

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References

  1. Raveenthiran V, Madiba TE, Atamanalp SS, De U (2010) Volvulus of the sigmoid colon. Colorectal Dis 12:E1–E17

    PubMed  CAS  Google Scholar 

  2. Atamanalp SS (2010) Sigmoid volvulus. EAJM 42:144–149

    Article  Google Scholar 

  3. Atamanalp SS, Ozturk G (2011) Sigmoid volvulus in the elderly: outcomes of a 43-year, 453-patient experience. Surg Today 41:514–519

    Article  PubMed  Google Scholar 

  4. Oren D, Atamanalp SS, Aydinli B et al (2007) An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Colon Rectum 50:489–497

    Article  PubMed  Google Scholar 

  5. Ballantyne GH, Brandner MD, Beart RW, Ilstrup DM (1985) Volvulus of the colon. Incidence and mortality. Ann Surg 202:83–92

    Article  PubMed  CAS  Google Scholar 

  6. Grossmann EM, Longo WE, Stratton MD, Virgo KS, Johnson FE (2000) Sigmoid volvulus in department of veterans affairs medical centers. Dis Colon Rectum 43:414–418

    Article  PubMed  CAS  Google Scholar 

  7. Påhlman L, Enblad P, Rudberg C, Krog M (1989) Volvulus of the colon. Acta Chir Scand 155:53–56

    PubMed  Google Scholar 

  8. Bak MP, Boley SC (1986) Sigmoid volvulus in elderly patients. Am J Surg 151:71–75

    Article  PubMed  CAS  Google Scholar 

  9. Avots-Avotins KV, Waugh DE (1982) Colon volvulus and geriatric patient. Surg Clin North Am 62:248–260

    Google Scholar 

  10. Heis HA, Bani-Hani KE, Rabadi DK et al (2008) Sigmoid volvulus in the Middle East. World J Surg 32:459–464

    Article  PubMed  Google Scholar 

  11. Lal SK, Morgenstern R, Vinjirayer EP, Matin A (2006) Sigmoid volvulus an update. Gastrointest Endosc Clin North Am 16:175–187

    Article  Google Scholar 

  12. Bhatnagar BN, Sharma CL, Gautam A, Kakar A, Reddy DC (2004) Gangrenous sigmoid volvulus: a clinical study of 76 patients. Int J Colorectal Dis 19:134–142

    Article  PubMed  CAS  Google Scholar 

  13. Raveenthiran V (2004) Observations on the pattern of vomiting and morbidity in patients with acute sigmoid volvulus. J Postgrad Med 50:27–29

    PubMed  CAS  Google Scholar 

  14. Raveenthiran V (2000) Emptiness of the left iliac fossa: a new clinical sign of sigmoid volvulus. Postgrad Med J 76:638–641

    Article  PubMed  CAS  Google Scholar 

  15. Arnold GJ, Nance FC (1973) Volvulus of the sigmoid colon. Ann Surg 177:527–537

    Article  PubMed  CAS  Google Scholar 

  16. Atamanalp SS, Yildirgan MI, Başoğlu M, Kantarci M, Yilmaz I (2004) Sigmoid colon volvulus in children: review of 19 cases. Pediatr Surg Int 20:492–495

    Article  PubMed  Google Scholar 

  17. Oncu M, Piskin B, Calik A et al (1991) Volvulus of the sigmoid colon. South Afr J Surg 29:48–49

    CAS  Google Scholar 

  18. Almog Y, Dranitzki-Elhalel M, Lax E, Zimmerman J, Glaser B (1992) Sigmoid volvulus presenting as chronic secretory diarrhea responsive to octreotide. Am J Gastroenterol 87:148–150

    PubMed  CAS  Google Scholar 

  19. Connolly S, Brannigan AE, Heffeman E, Hyland JM (2002) Sigmoid volvulus: a 10-year-audit. Ir J Med Sci 171:216–217

    Article  PubMed  CAS  Google Scholar 

  20. Atamanalp SS, Keles MS, Aydinli B (2009) Serum potassium levels in sigmoid volvulus. EAJM 41:143–145

    Google Scholar 

  21. Wai CT, Lau G, Khor CJL (2005) Clinics in diagnostic imaging. Singapore Med J 46:483–487

    PubMed  CAS  Google Scholar 

  22. Tsang TK, Siu KW, Lai A, Kwok PC, Chan S (2005) Images of interest: sigmoid volvulus. J Gastroenterol Hepatol 20:790

    Article  PubMed  CAS  Google Scholar 

  23. Slidell M, Samir SA, Feller ER (2004) Sigmoid volvulus in three college-age teenagers. J Clin Gastroenterol 38:910–911

    Article  PubMed  Google Scholar 

  24. Javors BR, Baker SR, Miller JA (1999) The northern exposure sign: a newly described finding in the sigmoid volvulus. AJR 173:571–574

    Article  PubMed  CAS  Google Scholar 

  25. Feldman D (2000) The coffee bean sign. Radiology 216:178–179

    PubMed  CAS  Google Scholar 

  26. Mellor MF, Drake DG (1994) Colonic volvulus in children: value of barium enema for diagnosis and treatment in 14 children. AJR Am J Roentgenol 162:1157–1159

    Article  PubMed  CAS  Google Scholar 

  27. Nizamuddin S, Qureshi S, Ghazanfar S (2008) Six-year experience of sigmoid volvulus. Pak J Surg 24:5–8

    Google Scholar 

  28. Chu EC, Tarnawski AS (2007) Rapid colonoscopic detection and quantification of colonic ischemia by using a laser doppler flow meter. Gastrointest Endosc 66:630–632

    Article  PubMed  Google Scholar 

  29. Catalano O (1996) Computed tomographic appearance of sigmoid volvulus. Abdom Imaging 21:314–317

    Article  PubMed  CAS  Google Scholar 

  30. Vega VMS, de Gracia MM, Sanchez AV (2010) Trapped on the ‘whirl’: diagnostic sign on emergency CT. Emerg Radiol 17:139–147

    Article  Google Scholar 

  31. Levsky JM, Den EI, DuBrow RA (2010) CT findings of sigmoid volvulus. AJR 194:136–143

    Article  PubMed  Google Scholar 

  32. Martínez-Ares D, Yáňez-López J, Souto-Ruzo J et al (2003) Indication and results of endoscopic management of sigmoid volvulus. Rev Esp Enferm Dig 95:544–548

    PubMed  Google Scholar 

  33. Brothers TE, Strodel WE, Eckhauser FE (1987) Endoscopy in colonic volvulus. Ann Surg 206:1–4

    Article  PubMed  CAS  Google Scholar 

  34. Starling JR (1979) Initial treatment of sigmoid volvulus by colonoscopy. Ann Surg 190:36–39

    Article  PubMed  CAS  Google Scholar 

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The author declares that he has no conflict of interest to the publication of this article.

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Authors and Affiliations

  1. Department of General Surgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey

    S. S. Atamanalp

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  1. S. S. Atamanalp
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Correspondence to S. S. Atamanalp.

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Atamanalp, S.S. Sigmoid volvulus: diagnosis in 938 patients over 45.5 years. Tech Coloproctol 17, 419–424 (2013). https://doi.org/10.1007/s10151-012-0953-z

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  • DOI: https://doi.org/10.1007/s10151-012-0953-z

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