Management of sigmoid volvulus: options and prognosis.

OBJECTIVE To describe the management of sigmoid volvulus with reference to the type of surgical procedures performed and to determine the prognosis of sigmoid volvulus. STUDY DESIGN A case series. PLACE AND DURATION OF STUDY Ghaem Hospital of Mashhad, University of Medical Sciences, Mashhad, Iran, from 1996 to 2008. METHODOLOGY A total of 944 cases of colon obstruction were reviewed. Demographic, laboratory and treatment results, mortality and complications were recorded. The data was analyzed using descriptive statistics as frequency and percentage for the qualitative variables and mean and standard deviation values for the quantitative variables. Also chisquare and Fisher's exact test were used for the association between the qualitative variables. SPSS statistical software (version 18) was used for the data analysis. RESULTS In all patients except those with symptoms or signs of gangrenous bowel, a long rectal tube was inserted via the rectosigmoidoscope which was successful in 80 (36.87%) cases. Rectosigmoidoscopic detorsion was unsuccessful in 137 (63.13%) patients, who underwent an emergent laparotomy. The surgical procedures performed in these cases were resection and primary anastomosis in 40 (29.1%), Mikulicz procedure in 9 (6.6%), laparotomy detorsion in 37 (27.01%), Hartmann procedure in 47 (34.3%), mesosigmoidoplasty in 3 (2.19%) patients and total colectomy in one (0.73%) case. The overall mortality was 9.8% (22) patients. CONCLUSION In sigmoid volvulus, the most important determinant of patient outcome is bowel viability. The initial treatment of sigmoid colon volvulus is sigmoidoscopy with rectal tube placement.