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The sigmoid volvulus: surgical timing and mortality for different clinical types.

Cirocchi R, Farinella E, La Mura F, Morelli U, Trastulli S, Milani D, Di Patrizi MS, Rossetti B, Spizzirri A, Galanou I, Kopanakis K, Mecarelli V, Sciannameo F - World J Emerg Surg (2010)

Bottom Line: We focused on 30-day postoperative mortality in relation to the surgical timing and procedure performed for each group.Conversely none of the patients treated with intestinal derotation and colopexy died.Mortality is higher in both obstructed patients with generalized peritonitis and patients affected by subocclusion with late diagnosis and surgical treatment; in both scenarios a Hartmann's procedure is the proper operation to be considered.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.

ABSTRACT

Background: In western countries intestinal obstruction caused by sigmoid volvulus is rare and its mortality remains significant in patients with late diagnosis. The aim of this work is to assess what is the correct surgical timing and how the prognosis changes for the different clinical types.

Methods: We realized a retrospective clinical study including all the patients treated for sigmoid volvulus in the Department of General Surgery, St Maria Hospital, Terni, from January 1996 till January 2009. We selected 23 patients and divided them in 2 groups on the basis of the clinical onset: patients with clear clinical signs of obstruction and patients with subocclusive symptoms. We focused on 30-day postoperative mortality in relation to the surgical timing and procedure performed for each group.

Results: In the obstruction group mortality rate was 44% and it concerned only the patients who had clinical signs and symptoms of peritonitis and that were treated with a sigmoid resection (57%). Conversely none of the patients treated with intestinal derotation and colopexy died. In the subocclusive group mortality was 35% and it increased up to 50% in those patients with a late diagnosis who underwent a sigmoid resection.

Conclusions: The mortality of patients affected by sigmoid volvulus is related to the disease stage, prompt surgical timing, functional status of the patient and his collaboration with the clinicians in the pre-operative decision making process. Mortality is higher in both obstructed patients with generalized peritonitis and patients affected by subocclusion with late diagnosis and surgical treatment; in both scenarios a Hartmann's procedure is the proper operation to be considered.

No MeSH data available.


Related in: MedlinePlus

Surgical timing and mortality in obstructed patients group.
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Figure 1: Surgical timing and mortality in obstructed patients group.

Mentions: The mean age of patients with obstruction was 76 years (69-85 years). In this group 4 patients were affected by >2 comorbidities and 5 patients by <2 comorbidities. Three patients were uncooperative and 2 of these were bed-bound. Four patients had clinical signs and symptoms of peritonitis and ileus, showing a diagnostic abdominal X-ray for sigmoid volvulus or intestinal occlusion, while the 5 remaining patients presented clinical and radiological signs of occlusion, but no clinical signs of peritonitis (Table 1). All the patients underwent emergency surgery; we performed a sigmoid resection in the 4 patients with clinical signs and symptoms of peritonitis and in 3 out of the 5 patients showing only clinical and radiological signs of occlusion, while an intestinal derotation with colopexy was performed in the 2 remaining patients. Mortality in the occlusive patients group was 44% (4/9), but if we also consider the obstructed patients with clinical signs and symptoms of peritonitis that were treated with a sigmoid resection, mortality rises up to 57% (4/7). Conversely none of the patients undergoing the intestinal derotation and colopexy died (Figure 1).


The sigmoid volvulus: surgical timing and mortality for different clinical types.

Cirocchi R, Farinella E, La Mura F, Morelli U, Trastulli S, Milani D, Di Patrizi MS, Rossetti B, Spizzirri A, Galanou I, Kopanakis K, Mecarelli V, Sciannameo F - World J Emerg Surg (2010)

Surgical timing and mortality in obstructed patients group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2820010&req=5

Figure 1: Surgical timing and mortality in obstructed patients group.
Mentions: The mean age of patients with obstruction was 76 years (69-85 years). In this group 4 patients were affected by >2 comorbidities and 5 patients by <2 comorbidities. Three patients were uncooperative and 2 of these were bed-bound. Four patients had clinical signs and symptoms of peritonitis and ileus, showing a diagnostic abdominal X-ray for sigmoid volvulus or intestinal occlusion, while the 5 remaining patients presented clinical and radiological signs of occlusion, but no clinical signs of peritonitis (Table 1). All the patients underwent emergency surgery; we performed a sigmoid resection in the 4 patients with clinical signs and symptoms of peritonitis and in 3 out of the 5 patients showing only clinical and radiological signs of occlusion, while an intestinal derotation with colopexy was performed in the 2 remaining patients. Mortality in the occlusive patients group was 44% (4/9), but if we also consider the obstructed patients with clinical signs and symptoms of peritonitis that were treated with a sigmoid resection, mortality rises up to 57% (4/7). Conversely none of the patients undergoing the intestinal derotation and colopexy died (Figure 1).

Bottom Line: We focused on 30-day postoperative mortality in relation to the surgical timing and procedure performed for each group.Conversely none of the patients treated with intestinal derotation and colopexy died.Mortality is higher in both obstructed patients with generalized peritonitis and patients affected by subocclusion with late diagnosis and surgical treatment; in both scenarios a Hartmann's procedure is the proper operation to be considered.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.

ABSTRACT

Background: In western countries intestinal obstruction caused by sigmoid volvulus is rare and its mortality remains significant in patients with late diagnosis. The aim of this work is to assess what is the correct surgical timing and how the prognosis changes for the different clinical types.

Methods: We realized a retrospective clinical study including all the patients treated for sigmoid volvulus in the Department of General Surgery, St Maria Hospital, Terni, from January 1996 till January 2009. We selected 23 patients and divided them in 2 groups on the basis of the clinical onset: patients with clear clinical signs of obstruction and patients with subocclusive symptoms. We focused on 30-day postoperative mortality in relation to the surgical timing and procedure performed for each group.

Results: In the obstruction group mortality rate was 44% and it concerned only the patients who had clinical signs and symptoms of peritonitis and that were treated with a sigmoid resection (57%). Conversely none of the patients treated with intestinal derotation and colopexy died. In the subocclusive group mortality was 35% and it increased up to 50% in those patients with a late diagnosis who underwent a sigmoid resection.

Conclusions: The mortality of patients affected by sigmoid volvulus is related to the disease stage, prompt surgical timing, functional status of the patient and his collaboration with the clinicians in the pre-operative decision making process. Mortality is higher in both obstructed patients with generalized peritonitis and patients affected by subocclusion with late diagnosis and surgical treatment; in both scenarios a Hartmann's procedure is the proper operation to be considered.

No MeSH data available.


Related in: MedlinePlus