Management of acute sigmoid volvulus: short- and long-term results
| Autor: | Benoit Desaint, Malika Bennis, M. Bruzzi, Isabelle Nion-Larmurier, Yann Parc, N. Chafai, Jérémie H. Lefevre, Emmanuel Tiret |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Percutaneous Decompression Peritonitis Risk Assessment Statistics Nonparametric Cohort Studies Abdominal wall Young Adult Sex Factors Colon Sigmoid medicine Humans Minimally Invasive Surgical Procedures Emergency Treatment Colectomy Aged Retrospective Studies Aged 80 and over business.industry Mortality rate Anastomosis Surgical Age Factors Gastroenterology Colonoscopy Long term results Middle Aged Decompression Surgical medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Acute Disease Female Sigmoid volvulus business Sigmoid resection Follow-Up Studies Intestinal Volvulus |
| Zdroj: | Colorectal Disease. 17:922-928 |
| ISSN: | 1462-8910 |
| DOI: | 10.1111/codi.12959 |
| Popis: | Aim The best form of prophylactic management of a decompressed sigmoid volvulus (SV) is controversial especially in the elderly. We have studied our experience with this condition to assess the short- and long-term results of SV management. Method All patients treated for SV in our department between 2003 and 2013 were retrospectively included. Emergency decompression was attempted in all patients in whom there was no sign of peritonitis. Planned surgical resection was the procedure of choice in young patients. Percutaneous endoscopic colopexy (PEC) was used in high surgical risk patients. Results There were 65 patients (45 males) of median age 71.5 (24–99) years. Non-surgical reduction was performed in 62 with a success rate of 95% (59/62). Recurrence after initial decompression was 67% at a median follow-up of 5 (1–14) years. A prophylactic surgical resection was performed with primary anastomosis in 33 patients. There were no deaths and the major morbidity rate was 6%. At a mean follow-up of 62 months, only 1 (3%) patient had had a recurrence (at 130 months). PEC was performed in six patients of median age 90 (84–99) years and with a median American Society of Anesthesiologists score of 4. Complications included local site infection (n = 2), pain (n = 1) and abdominal wall bleeding (n = 1). After a median follow-up of 2 (1–4) years, three patients died from medical causes and one recurrence occurred 13 months after removal of the PEC tube. Conclusion Prophylactic treatment after initial decompression of SV results in a low rate of recurrence. Planned sigmoid resection is safe and effective. In frail elderly patients, PEC is satisfactory. |
| Databáze: | OpenAIRE |
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