Outcomes for sigmoid volvulus managed with and without early definitive surgery: 20‐year experience in a tertiary referral centre

Abstract

AbstractBackgroundSigmoid volvulus is rare in Western countries. Patients at risk of sigmoid volvulus are often older with significant co‐morbidity. Without sigmoid colectomy there is a high recurrence rate, but indications for surgery are controversial.MethodsA retrospective observational study was conducted by reviewing clinical records of patients admitted to Waikato Hospital 1 January 2000 to 1 January 2020 with a diagnosis of sigmoid volvulus. Patient characteristics, clinical features, investigations, management, and outcomes were recorded.ResultsOne hundred and thirty‐two patients (87 male) were included with 203 volvulus episodes. Median age 76 years, median Charlson co‐morbidity index (CCI) 4. Median follow‐up 11 years. 44/132 (33.3%) had surgery during the index admission, two had elective surgery and the remainder had planned non‐operative management. 73/132 (55.3%) had surgery at any stage. 42/86 (48.8%) patients managed non‐operatively recurred; 66.7% of recurrences were within 6 months. Forty‐three (32.6%) died within 12 months of index admission; 28 (21.2%) died during an admission for volvulus. On univariate analysis higher age and abnormal vital signs were associated with inpatient and 12‐month mortality; higher CCI was associated with 12‐month mortality. On multi‐variate analysis increasing age in years was associated with increased risk of death (HR 1.089 [1.052–1.128, P < 0.001]). Normal vital signs at presentation were associated with decreased risk of death (HR 0.147 [0.065–0.334, P < 0.001]).ConclusionSigmoid colectomy should be considered at index presentation with sigmoid volvulus. Half of patients managed non‐operatively recurred, with two‐thirds recurring within 6 months. The mortality rate remains high for subsequent volvulus episodes.