Sigmoid Volvulus: 10-year Report from Maharat Nakhon Ratchasima Hospital

Sigmoid volvulus, the torsion or twisting of the sigmoid colon on its mesenteric pedicle, is an uncommon cause of colonic obstruction in adults. This study aimed to review patient characteristics and outcomes of sigmoid volvulus at Maharat Nakhon Ratchasima Hospital, Thailand. Methods: Retrospective medical record reviews were conducted for adult patients (age≥18 years) who had been diagnosed with sigmoid volvulus from January 2010 to December 2019. Data were analyzed using the Stata program. Results: Forty-two patients were diagnosed with sigmoid volvulus during the 10-year period; 34 (80%) were males with an average age of 64.6±11.7 years. The two most common comorbidities were hypertension (33.3%) and bedridden status (14.2%). Colonoscopic detorsion was attempted in 17 patients (40.5%) and was successful in 13 of 17 patients (success rate 76.5%). Sigmoidectomy was performed in 32 patients, including 5 cases of elective surgery after colonoscopic detorsion and 27 cases of urgent surgery or failed detorsion. Primary anastomosis was done in 15 patients and end colostomy was done in 17 patients. The 30-day mortality rate was 9.5%. Sigmoid necrosis was associated with a risk of mortality (P=0.018). Cases presenting between 2015-2019 had a significantly higher rate of colonoscopic detorsion and less sigmoidectomy with end colostomy than those presenting between 2010-2014. Conclusion: Our data indicate that a move toward standard management of sigmoid volvulus can be seen in our hospital. Endoscopic detorsion should be the initial management of patients without peritonitis. Sigmoidectomy should be done in the same index admission.