Annals of Coloproctology

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Benign GI diease

Surgical Management of Sigmoid Volvulus: A Multicenter Observational Study: Keunchul Lee, Heung-Kwon Oh, Jung Rae Cho, Minhyun Kim, Duck-Woo Kim, Sung-Bum Kang, Hyung-Jin Kim, Hyoung-Chul Park, Rumi Shin, Seung Chul Heo, Seung-Bum Ryoo, Kyu Joo Park, Seoul Colorectal Research Group (SECOG); Ann Coloproctol. 2020;36(6):403-408. Published online December 31, 2020; DOI: https://doi.org/10.3393/ac.2020.03.23

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17 Web of Science
14 Citations

Purpose
This study aimed to evaluate real-world clinical outcomes from surgically treated patients for sigmoid volvulus.
Methods
Five tertiary centers participated in this retrospective study with data collected from October 2003 through September 2018, including demographic information, preoperative clinical data, and information on laparoscopic/open and elective/emergency procedures. Outcome measurements included operation time, postoperative hospitalization, and postoperative morbidity.
Results
Among 74 patients, sigmoidectomy was the most common procedure (n = 46), followed by Hartmann’s procedure (n = 23), and subtotal colectomy (n = 5). Emergency surgery was performed in 35 cases (47.3%). Of the 35 emergency patients, 34 cases (97.1%) underwent open surgery, and a stoma was established for 26 patients (74.3%). Elective surgery was performed in 39 cases (52.7%), including 21 open procedures (53.8%), and 18 laparoscopic surgeries (46.2%). Median laparoscopic operation time was 180 minutes, while median open surgery time was 130 minutes (P < 0.001). Median postoperative hospitalization was 11 days for laparoscopy and 12 days for open surgery. There were 20 postoperative complications (27.0%), and all were resolved with conservative management. Emergency surgery cases had a higher complication rate than elective surgery cases (40.0% vs. 15.4%, P = 0.034).
Conclusion
Relative to elective surgery, emergency surgery had a higher rate of postoperative complications, open surgery, and stoma formation. As such, elective laparoscopic surgery after successful sigmoidoscopic decompression may be the optimal clinical option.

Citations

Citations to this article as recorded by

Mesopexy instead of colectomy successfully treated an elderly patient with sigmoid volvulus, a case report
Jin Qian, Shu-Qing Hua
Asian Journal of Surgery.2025; 48(2): 1441. CrossRef
Outcomes for sigmoid volvulus managed with and without early definitive surgery: 20‐year experience in a tertiary referral centre
Shriranshini Satheakeerthy, Priscilla Leow, Benjamin Hall, Damien Ah Yen, Jesse Fischer
ANZ Journal of Surgery.2024; 94(1-2): 169. CrossRef
Patience is key: Association of surgical timing with clinical outcomes in elderly patients with sigmoid volvulus
Suzanne C. Arnold, Wardah Rafaqat, May Abiad, Emanuele Lagazzi, Anne H. Hoekman, Vahe S. Panossian, Ikemsinachi C. Nzenwa, Charudutt N. Paranjape, George C. Velmahos, Haytham M.A. Kaafarani, John O. Hwabejire
The American Journal of Surgery.2024; 232: 81. CrossRef
Epidemiology and age-related trends in surgical outcomes for sigmoid volvulus: a 17-year analysis
Lukas Schabl, Stefan D. Holubar, Kamil Erozkan, Ali Alipouriani, Himani Sancheti, Scott R. Steele, Hermann Kessler
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Unveiling a Coalescing Catastrophe: Pre-pyloric Perforation Co-existing With Sigmoid Volvulus in a Middle-Aged Patient
Mihir Patil, Pankaj Gharde
Cureus.2024;[Epub] CrossRef
Navigating Abdominal Volvulus: A Comprehensive Review of Management Strategies
Simran Chauhan, Raju K Shinde, Yashraj Jain
Cureus.2024;[Epub] CrossRef
Laparoscopic redo surgery for sigmoid volvulus following laparoscopic sigmoidectomy
Hideyuki Masui, Kenji Kawada, Susumu Inamoto, Toshiaki Wada, Yoshiharu Sakai, Kazutaka Obama
Surgical Case Reports.2024;[Epub] CrossRef
Sigmoid volvulus as a rare cause of intestinal obstruction in the pediatric population: case series and literature review
Isabel C. Brito Rojas, Mayra A. Hernández Peñuela, Vanessa Medina Gaviria, Martin La Rotta, John M. Escobar Echeverri
International Journal of Surgery Open.2024; 62(2): 149. CrossRef
Metachronous volvulus of the descending colon after resection of the sigmoid volvulus; a case report
Molla Asnake Kebede, Sisay Mengistu Mohammed, Yilkal Teshome Numaro, Yohanes Yoseph Mesfine, Adugnaw Bogale Worku, Anteneh Messele Birhanu
International Journal of Surgery Case Reports.2024; 123: 110212. CrossRef
Left iliac fossa sigmoidectomy with mechanical anastomosis in the management of uncomplicated sigmoid volvulus: an observational study at Principal Hospital of Dakar, Senegal
Eugene Gaudens Prosper Amaye Dieme, Birame Ndiaye, Magatte Faye, Samba Tiapato Faye, Moustapha Diop, Madawas Mboup, Ibrahima Sall, Oumar Fall, Alamasso Sow
The Pan African Medical Journal.2024;[Epub] CrossRef
Bowel Preparation Before Nonelective Sigmoidectomy for Sigmoid Volvulus: Highly Beneficial but Vastly Underused
Natalie Schudrowitz, C Patrick Shahan, Tovah Moss, John E Scarborough
Journal of the American College of Surgeons.2023; 236(4): 649. CrossRef
Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study
Tilahun Deresse, Esubalew Tesfahun, Zenebe Gebreegziabher, Mandante Bogale, Dawit Alemayehu, Megbar Dessalegn, Tewodros Kifleyohans, George Eskandar
Open Access Emergency Medicine.2023; Volume 15: 383. CrossRef
Colonic pseudo-obstruction in a patient with dyssynergic defecation: A case report
Yejun Jeong, Yongjae Kim, Wonhyun Kim, Seoyeon Park, Su-Jin Shin, Eun Jung Park
International Journal of Surgery Case Reports.2022; 98: 107524. CrossRef
Comments on “Surgical Management of Sigmoid Volvulus: A Multicenter Observational Study”
Sabri Selcuk Atamanalp
Annals of Coloproctology.2021; 37(2): 73. CrossRef

Benign GI diease

Acute Colonic Volvulus in a Mexican Population: A Case Series: Mauricio Gonzalez-Urquijo, Mario Rodarte-Shade, Gerardo Gil-Galindo; Ann Coloproctol. 2020;36(1):48-53. Published online February 18, 2020; DOI: https://doi.org/10.3393/ac.2019.01.02

4,890 View
117 Download
8 Web of Science
6 Citations

Abstract PDF

Purpose
Colonic volvulus constitutes a significant cause of large bowel obstruction in adults. Most studies of colonic volvulus come from high endemic zones and are limited by the small number of patients. In our region, there is a shortage of studies concerning this disorder, and treatment of colonic volvulus remains controversial.
Methods
This is a retrospective study of 34 patients who presented with colonic volvulus at a single academic institution in a 4-year period and their respective treatment and outcomes.
Results
A total of 34 patients, 17 males (50%) and 17 females (50%), with a mean age of 55 ± 23.9 years underwent treatment for colonic volvulus. Twelve patients (35.3%) underwent initial decompression, followed by a Hartman procedure in 4 patients (11.7%) and sigmoid resection with primary anastomosis in 3 patients (8.8%), with 3 fatalities (8.8%) following initial decompression. Two patients (5.8%) were lost to follow-up. Twenty-two patients (64.7%) underwent emergency surgery, of whom 16 (47%) underwent a Hartman procedure, with colorectal anastomosis in 9 patients (26.4%), with 3 fatalities (8.8%) immediately after the first procedure. Four patients (11.7%) were lost to follow up after the Hartman procedure. Of the 6 remaining patients (17.6%), of the emergency surgical group, 3 patients (8.8%) had an initial sigmoidectomy and primary anastomosis, and the remaining 3 patients (8.8%) had a cecal volvulus with a right hemicolectomy performed with primary anastomosis in 2 patients (5.8%) and with a fatality in the remaining patient, on whom a terminal ileostomy was performed for damage control. The mean hospital stay was 5.7 days, with an overall mortality rate of 23.5%.
Conclusion
Acute colonic volvulus in our region is not as uncommon as in other parts of the world. This disorder must be suspected when a patient presents with abdominal pain, abdominal distension, and bean sign on plain X-rays and/or a whirl sign on computed tomography scan.

Citations

Citations to this article as recorded by

Metachronous descending colon volvulus after sigmoidectomy: a case report
Asratu G Amare, Gebrehiwot A Workneh, Mequanint T Tassew, Minale M Kebede, Mengist A Tegegne, Michael A Negussie
Journal of Surgical Case Reports.2024;[Epub] CrossRef
Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States
Dushyant Singh Dahiya, Abhilash Perisetti, Hemant Goyal, Sumant Inamdar, Amandeep Singh, Rajat Garg, Chin-I Cheng, Mohammad Al-Haddad, Madhusudhan R. Sanaka, Neil Sharma
Clinical Endoscopy.2023; 56(3): 340. CrossRef
Endoscopic Decompression of Sigmoid Volvulus: Review of 748 Patients
Sabri Selcuk Atamanalp
Journal of Laparoendoscopic & Advanced Surgical Techniques.2022; 32(7): 763. CrossRef
Recommendations for the Management of Sigmoid Volvulus
Sabri Selcuk Atamanalp
Diseases of the Colon & Rectum.2022; 65(2): e85. CrossRef
Colonic pseudo-obstruction in a patient with dyssynergic defecation: A case report
Yejun Jeong, Yongjae Kim, Wonhyun Kim, Seoyeon Park, Su-Jin Shin, Eun Jung Park
International Journal of Surgery Case Reports.2022; 98: 107524. CrossRef
Comments on “Acute Colonic Volvulus in a Mexican Population: A Case Series”
Sabri Selcuk Atamanalp
Annals of Coloproctology.2021; 37(3): 131. CrossRef

Case Reports

Laparoscopic Management of Sigmoid Volvulus for Which Endoscopic Reduction had Failed.: Choi, Sung Il , Lee, Suk Hwan; J Korean Soc Coloproctol. 2008;24(5):390-393.; DOI: https://doi.org/10.3393/jksc.2008.24.5.390

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1 Citations

Abstract PDF

The laparoscopic approach to the treatment of sigmoid volvulus has been challenging because of the different anatomy of the colon and the mesentery. We report a case of a laparoscopic sigmoidectomy and anastomosis for a patient with sigmoid volvulus for whom endoscopic reduction had failed. A 68-year-old man with sigmoid colon volvulus underwent laparoscopic surgery. The laparoscopic surgery was difficult because of the tortuous and dilated bowel and the many fibrous bands. We performed an intraoperative decompression by using a rectal tube through the anus and a primary anastomosis without on- table preparation. The patient was discharged six days later without complications. We assumed that laparoscopic resection and anastomosis is a safe, effective procedure for the management of sigmoid volvulus.

Citations

Citations to this article as recorded by

Single-port laparoscopic surgery for sigmoid volvulus
Byung Jo Choi
World Journal of Gastroenterology.2015; 21(8): 2381. CrossRef

Colonic Obstruction Caused by Sigmoid Volvulus Combined with a Transomental Hernia: A Case Report.: Choi, Pyong Wha , Heo, Tae Gil , Park, Je Hoon , Lee, Myung Soo , Kim, Chul Nam , Chang, Surk Hyo , Kim, Nam Hoon , Bae, Won Ki , Moon, Young Soo; J Korean Soc Coloproctol. 2008;24(3):214-218.; DOI: https://doi.org/10.3393/jksc.2008.24.3.214

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7 Download

Abstract PDF: The case of sigmoid volvulus combined with a transomental hernia is reported. A 70-year-old man was admitted to our hospital with mild abdominal pain and distension. Although no signs of peritoneal irritation were apparent, a plain abdominal X-ray showed a markedly dilated loop of the sigmoid colon, and CT revealed a whirl pattern of the sigmoid mesentery. These findings suggested sigmoid volvulus. Colonoscopic reduction was attempted as an initial nonoperative treatment, and an urgent laparotomy was performed after the reduction failed. The sigmoid loop was herniated through the great omentum, with torsion in the clockwise direction. The colon was manually untwisted in the counter-clockwise direction, and the sigmoid loop was released by dividing the great omentum. During this one-stage operation, intraoperative colonic irrigation, sigmoid resection, and primary anastomosis were performed. The postoperative course was uneventful. Although sigmoid volvulus combined with a transomental hernia is rare, urgent surgical intervention is essential on failure of endoscopic reduction.

Original Articles

A Case of Idiopathic Megacolon Associated with Sigmoid Volvulus.: Yeom, Joo Jin , Choi, Ji Hun , Kim, Ji Woong , Kim, Sang Wook , Kim, Tae Hyeon , Choi, Suk Chae , Lee, Jung Gyun , Yun, Ki Jung , Nah, Young Ho; J Korean Soc Coloproctol. 2002;18(2):133-136.

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32 Download

Abstract PDF: Megacolon is an uncommon condition in which the bowel is persistently of increased diameter and it is always associated with long-standing constipation. Two main groups are recognized according to whether or not ganglia are present in the intermuscular plane of the rectal wall. Their complete absence, even along a short segment of rectum, denotes Hirschspurung's disease. If ganglia are present, the dilated bowel may be secondary to some predisposing factor such as a stricture, a congenital anorectal abnormality, a cauda equina lesion etc. In other instances, however, there may be no apparent organic reason as to why the bowel should be so dilated. This latter condition is termed "idiopathic megacolon". We report the case of one female patient with idiopathic megacolon. During medical treatment, she was complicated with a sigmoid volvulus, we performed subtotal colectomy and cecorectal anastomosis and she improved without any complication.

Sigmoid Volvulus: Is Surgical Treatment Mandatory?.: Park, In Ja , Yu, Chang Sik , Cho, Young Kyu , Hong, Hyoun Kee , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2001;17(5):232-238.

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12 Download

Abstract PDF: PURPOSE
The standard treatment for sigmoid volvulus has been considered as a resection of involved segment after nonoperative decompression. This study was performed to investigate the clinical characteristics and compare the results of managements in patients with sigmoid volvulus.
METHODS
We recruited twelve patients with sigmoid volvulus registered and treated at Asan Medical Center during 1989 and 1999. The medical records were reviewed retrospectively. Telephone inerviews were performed to inquire recent status. We analyzed clinical variables including symptoms on admission, physical findings, findings of radiologic studies, managements and their outcomes. The median age was 64 years (range:45 to 84 years). The median follow-up period was 46 months (range:2 to 94).
RESULTS
Nine patients among twelve were male. Presenting symptoms were abdominal pain (92%), abdominal distension (67%), constipation (50%) and hematochezia. The diagnostic modalities utilized included plain film of the abdomen, CT scan and sigmoidoscopy. Nine cases (75%) were correctly diagnosed prior to operation, of which eight (67%) were diagnosed by plain film. The remaining three cases were by operation. In these cases, preoperative diagnoses were ischemic colitis and obstruction due to colonic malignancy. In seven cases, only nonoperative managements were employed. Nonoperative management included decompression by nasogastric tube or rectal tube insertion and use of bulk forming agents and stool softner afterwards to improve bowel habits. Five patients underwent anterior resection. We couldn't perform surgery in seven cases because of high operative risk due to underlying serious medical conditions such as bronchial asthma, malignancies and refusal by the patients after clinical improvement in 4 and 3cases, respectively. Three of them were died of underlying disease or sepsis. Recurrence occurred in two patients (50%) who underwent nonoperative management only and none in patients who underwent surgical intervention.
CONCLUSIONS
In patients with sigmoid volvulus, elective surgery after appropriate nonoperative management is mandatory to prevent recurrence and fatal outcome, especially in good surgical risk patients. Considerable patients, however, did not undergo surgery due to poor physical status or refusal of surgery.

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