Contemporary Management of Sigmoid Volvulus

Scott C. Dolejs, Michael J. Guzman, Alyssa D. Fajardo, Bryan Holcomb, Bruce Robb, Joshua A. Waters

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background: Sigmoid volvulus is an uncommon cause of bowel obstruction that is historically associated with high morbidity and mortality. The objective of this study was to evaluate contemporary management of sigmoid volvulus and the safety of primary anastomosis in patients with sigmoid volvulus. Methods: The National Surgical Quality Improvement Project from 2012 to 2015 was queried for patients with colonic volvulus who underwent left-sided colonic resection. A propensity score-matched analysis was performed to compare patients with sigmoid volvulus undergoing colectomy with primary anastomosis without proximal diversion to colectomy with end colostomy. Results: Two thousand five hundred thirty-eight patients with sigmoid volvulus were included for analysis. Patients had a median age of 68 years (interquartile range, 55–80) and 79% were fully independent preoperatively. Fifty-one percent of operations were performed emergently. One thousand eight hundred thirteen (71%) patients underwent colectomy with anastomosis, 240 (10%) colectomy with anastomosis and proximal diversion, and 485 (19%) colectomy with end colostomy. Overall, 30-day mortality and morbidity were 5 and 40%, respectively. After propensity score matching, mortality, overall morbidity, and serious morbidity were similar between groups. Conclusions: Sigmoid volvulus occurs in elderly and debilitated patients with significant morbidity, mortality, and lifestyle implications. In selected patients, anastomosis without proximal diversion in patients with sigmoid volvulus results in similar outcomes to colectomy with end colostomy.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Mar 22 2018

    Fingerprint

Keywords

  • Colectomy
  • Colostomy
  • Intestinal volvulus
  • Sigmoid volvulus

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this