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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.


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Surgical timing and mortality in subocclusive patients group.
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Figure 2: Surgical timing and mortality in subocclusive patients group.

Mentions: An early diagnosis was only possible in the patients who underwent a CT scan, which showed typical signs of sigmoid occlusion. A sigmoid resection was performed in 4 patients and an intestinal derotation with colopexy was performed in 2 patients. One of the patients treated with sigmoid resection died on the 4th postoperative day. Mortality in the subocclusive patients with earlier CT diagnosis of volvulus was 16% (1/6). On the other hand in the 8 patients treated conservatively without CT scan, clinical and radiological signs of occlusion occurred within 48-72 hours, while 4 of them developed clinical signs and symptoms of peritonitis. For this reason all of them underwent a sigmoid resection in emergency. Four of them died within the 7th postoperative day (50%). Mortality in the subocclusive patients group with delayed diagnosis was 50% (4/8) (Figure 2).


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 subocclusive patients group.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Surgical timing and mortality in subocclusive patients group.
Mentions: An early diagnosis was only possible in the patients who underwent a CT scan, which showed typical signs of sigmoid occlusion. A sigmoid resection was performed in 4 patients and an intestinal derotation with colopexy was performed in 2 patients. One of the patients treated with sigmoid resection died on the 4th postoperative day. Mortality in the subocclusive patients with earlier CT diagnosis of volvulus was 16% (1/6). On the other hand in the 8 patients treated conservatively without CT scan, clinical and radiological signs of occlusion occurred within 48-72 hours, while 4 of them developed clinical signs and symptoms of peritonitis. For this reason all of them underwent a sigmoid resection in emergency. Four of them died within the 7th postoperative day (50%). Mortality in the subocclusive patients group with delayed diagnosis was 50% (4/8) (Figure 2).

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