Intest Res.  2017 Apr;15(2):215-220. 10.5217/ir.2017.15.2.215.

Clinical outcomes of sigmoid colon volvulus: identification of the factors associated with successful endoscopic detorsion

• Iida T
• Nakagaki S
• Satoh S
• Shimizu H
• Kaneto H
• Nakase H

• KMID: 2425164
• DOI: http://doi.org/10.5217/ir.2017.15.2.215

Abstract

BACKGROUND/AIMS
Although multiple treatment options exist for the management of sigmoid colon volvulus, no study has examined the factors associated with successful endoscopic detorsion. This study aimed to examine the clinical course of patients with sigmoid colon volvulus and to identify factors related to successful endoscopic detorsion.
METHODS
This study included 30 cases (21 patients) of sigmoid volvulus from among 545 cases of intestinal obstruction at a single center. We retrospectively examined the clinical course and the factors associated with the possibility of endoscopic detorsion of sigmoid colon volvulus.
RESULTS
The rate of laxative use among the study participants was 76.2%; the rate of comorbid neuropsychiatric disorders was 61.9%; and 57.1% of patients had a history of open abdominal surgery. All patients were initially treated with endoscopic detorsion, and this procedure had a 61.9% success rate. The recurrence rate after detorsion was as high as 46.2%, but detorsion during revision endoscopy was possible in all cases. Statistical analysis revealed that the absence of abdominal tenderness (P=0.027), the use of laxatives (P=0.027), and a history of open abdominal surgery (P=0.032) were factors predictive of successful endoscopic detorsion.
CONCLUSIONS
The results of our study are consistent with previous reports with respect to the success rate of endoscopic detorsion, the subsequent recurrence rate, and the proportion of patients requiring surgical treatment. In addition, we identified the absence of abdominal tenderness, the use of laxatives, and history of open abdominal surgery as factors predicting successful endoscopic detorsion of sigmoid colon volvulus.

Keyword

Intestinal volvulus; Intestinal obstruction; Colonoscopy; Sigmoidoscopy

MeSH Terms

Colon, Sigmoid*
Colonoscopy
Endoscopy
Humans
Intestinal Obstruction
Intestinal Volvulus*
Laxatives
Recurrence
Retrospective Studies
Sigmoidoscopy
Laxatives

Figure

• 

  Fig. 1 Abdominal CT findings. Contrast-enhanced CT showed that the bent inner tube sign (A, arrow) was positive, indicating a markedly dilated sigmoid colon, and that the whirl pattern (B, arrow) was also positive, suggesting torsion of the intestinal tract and rotation of the mesentery; the patient was diagnosed with sigmoid colon volvulus. However, there was no clear evidence of intestinal ischemia.

• 

  Fig. 2 Sigmoidoscopic findings. Endoscopic detorsion was attempted using lower gastrointestinal endoscopy, but the intestinal lumen was narrowed at a site located 20 cm from the anal verge, and the mucosa displayed a white color, suggesting intestinal ischemia.

• 

  Fig. 3 Clinical course of sigmoid colon volvulus.

Reference

1. Påhlman L, Enblad P, Rudberg C, Krog M. Volvulus of the colon: a review of 93 cases and current aspects of treatment. Acta Chir Scand. 1989; 155:53–56. PMID: 2929205.

2. Oncü M, Pískín B, Calik A, Yandi M, Alhan E. Volvulus of the sigmoid colon. S Afr J Surg. 1991; 29:48–49. PMID: 1882313.

3. Halabi WJ, Jafari MD, Kang CY, et al. Colonic volvulus in the United States: trends, outcomes, and predictors of mortality. Ann Surg. 2014; 259:293–301. PMID: 23511842.

4. Kasten KR, Marcello PW, Roberts PL, et al. What are the results of colonic volvulus surgery? Dis Colon Rectum. 2015; 58:502–507. PMID: 25850837.

5. Brothers TE, Strodel WE, Eckhauser FE. Endoscopy in colonic volvulus. Ann Surg. 1987; 206:1–4. PMID: 3606228.

6. Hiltunen KM, Syrjä H, Matikainen M. Colonic volvulus: diagnosis and results of treatment in 82 patients. Eur J Surg. 1992; 158:607–611. PMID: 1363066.

7. Oren D, Atamanalp SS, Aydinli B, et al. An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Colon Rectum. 2007; 50:489–497. PMID: 17205203.

8. Akinkuotu A, Samuel JC, Msiska N, Mvula C, Charles AG. The role of the anatomy of the sigmoid colon in developing sigmoid volvulus: a case-control study. Clin Anat. 2011; 24:634–637. PMID: 21322064.

9. Asbun HJ, Castellanos H, Balderrama B, et al. Sigmoid volvulus in the high altitude of the Andes: review of 230 cases. Dis Colon Rectum. 1992; 35:350–353. PMID: 1582356.

10. Isbister WH. Large bowel volvulus. Int J Colorectal Dis. 1996; 11:96–98. PMID: 8739835.

11. Safioleas M, Chatziconstantinou C, Felekouras E, et al. Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly: a study of 33 cases. World J Gastroenterol. 2007; 13:921–924. PMID: 17352024.

12. Tan KK, Chong CS, Sim R. Management of acute sigmoid volvulus: an institution's experience over 9 years. World J Surg. 2010; 34:1943–1948. PMID: 20372894.

13. Atamanalp SS. Treatment of sigmoid volvulus: a single-center experience of 952 patients over 46.5 years. Tech Coloproctol. 2013; 17:561–569. PMID: 23636444.

14. Larkin JO, Thekiso TB, Waldron R, Barry K, Eustace PW. Recurrent sigmoid volvulus: early resection may obviate later emergency surgery and reduce morbidity and mortality. Ann R Coll Surg Engl. 2009; 91:205–209. PMID: 19335969.

15. Dülger M, Cantürk NZ, Utkan NZ, Gonullu NN. Management of sigmoid colon volvulus. Hepatogastroenterology. 2000; 47:1280–1283. PMID: 11100333.

16. Khanna AK, Kumar P, Khanna R. Sigmoid volvulus: study from a north Indian hospital. Dis Colon Rectum. 1999; 42:1081–1084. PMID: 10458135.