The sigmoid volvulus: surgical timing and mortality for different clinical types.
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.
Cirocchi
Roberto
R
Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.
Farinella
Eriberto
E
Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.
La Mura
Francesco
F
Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.
Morelli
Umberto
U
Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.
Trastulli
Stefano
S
Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.
Milani
Diego
D
Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.
Di Patrizi
Micol S
MS
Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.
Rossetti
Barbara
B
Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.
Spizzirri
Alessandro
A
Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.
Galanou
Ioanna
I
Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.
Kopanakis
Konstandinos
K
III Department of Surgery, Attikon University Hospital, Athens, Greece.
Mecarelli
Valerio
V
Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.
Sciannameo
Francesco
F
Department of General Surgery, St Maria Hospital, Terni, University of Perugia, Italy.