Recurrent sigmoid volvulus - early resection may obviate later emergency surgery and reduce morbidity and mortality.

Hdl Handle:
http://hdl.handle.net/10147/203229
Title:
Recurrent sigmoid volvulus - early resection may obviate later emergency surgery and reduce morbidity and mortality.
Authors:
Larkin, J O; Thekiso, T B; Waldron, R; Barry, K; Eustace, P W
Affiliation:
Department of Surgery, Mayo General Hospital, Castlebar, Co. Mayo, Ireland., larkin.dundalk@gmail.com
Citation:
Ann R Coll Surg Engl. 2009 Apr;91(3):205-9.
Journal:
Annals of the Royal College of Surgeons of England
Issue Date:
31-Jan-2012
URI:
http://hdl.handle.net/10147/203229
DOI:
10.1308/003588409X391776
PubMed ID:
19335969
Abstract:
INTRODUCTION: Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction. PATIENTS AND METHODS: We reviewed our unit's experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS: Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS: Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.
Language:
eng
MeSH:
Acute Disease; Aged; Aged, 80 and over; Colonic Diseases/mortality/*surgery; Colonoscopy/statistics & numerical data; Decompression, Surgical/statistics & numerical data; Emergency Treatment; Female; Humans; Intestinal Volvulus/mortality/*surgery; Intraoperative Complications/etiology; Male; Middle Aged; Recurrence/prevention & control; Survival Analysis; Treatment Outcome
ISSN:
1478-7083 (Electronic); 0035-8843 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorLarkin, J Oen_GB
dc.contributor.authorThekiso, T Ben_GB
dc.contributor.authorWaldron, Ren_GB
dc.contributor.authorBarry, Ken_GB
dc.contributor.authorEustace, P Wen_GB
dc.date.accessioned2012-01-31T15:55:06Z-
dc.date.available2012-01-31T15:55:06Z-
dc.date.issued2012-01-31T15:55:06Z-
dc.identifier.citationAnn R Coll Surg Engl. 2009 Apr;91(3):205-9.en_GB
dc.identifier.issn1478-7083 (Electronic)en_GB
dc.identifier.issn0035-8843 (Linking)en_GB
dc.identifier.pmid19335969en_GB
dc.identifier.doi10.1308/003588409X391776en_GB
dc.identifier.urihttp://hdl.handle.net/10147/203229-
dc.description.abstractINTRODUCTION: Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction. PATIENTS AND METHODS: We reviewed our unit's experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS: Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS: Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.en_GB
dc.language.isoengen_GB
dc.subject.meshAcute Diseaseen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshColonic Diseases/mortality/*surgeryen_GB
dc.subject.meshColonoscopy/statistics & numerical dataen_GB
dc.subject.meshDecompression, Surgical/statistics & numerical dataen_GB
dc.subject.meshEmergency Treatmenten_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIntestinal Volvulus/mortality/*surgeryen_GB
dc.subject.meshIntraoperative Complications/etiologyen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshRecurrence/prevention & controlen_GB
dc.subject.meshSurvival Analysisen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titleRecurrent sigmoid volvulus - early resection may obviate later emergency surgery and reduce morbidity and mortality.en_GB
dc.contributor.departmentDepartment of Surgery, Mayo General Hospital, Castlebar, Co. Mayo, Ireland., larkin.dundalk@gmail.comen_GB
dc.identifier.journalAnnals of the Royal College of Surgeons of Englanden_GB
dc.description.provinceConnacht-

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