title: More patients should undergo surgery after sigmoid volvulus.
abstract: OBJECTIVE
  To assess the outcome of patients treated conservatively vs surgically during their first admission for sigmoid volvulus.
  
  
  METHODS
  We conducted a retrospective study of 61 patients admitted to Aarhus University Hospital in Denmark between 1996 and 2011 for their first incidence of sigmoid volvulus. The condition was diagnosed by radiography, sigmoidoscopy or surgery. Patients treated with surgery underwent either a sigmoid resection or a percutaneous endoscopic colostomy (PEC). Conservatively treated patients were managed without surgery. Data was recorded into a Microsoft Access database and calculations were performed with Microsoft Excel. Kaplan-Meier plotting and Mantel-Cox (log-rank) testing were performed using GraphPad Prism software. Mortality was defined as death within 30 d after intervention or surgery.
  
  
  RESULTS
  Among the total 61 patients, 4 underwent emergency surgery, 55 underwent endoscopy, 1 experienced resolution of the volvulus after contrast enema, and 1 died without treatment because of large bowel perforation. Following emergency treatment, 28 patients underwent sigmoid resection (semi-elective n = 18; elective n = 10). Two patients who were unfit for surgery underwent PEC and both died, 1 after 36 d and the other after 9 mo, respectively. The remaining 26 patients were managed conservatively without sigmoid resection. Patients treated conservatively on their first admission had a poorer survival rate than patients treated surgically on their first admission (95%CI: 3.67-14.37, P = 0.036). Sixty-three percent of the 26 conservatively treated patients had not experienced a recurrence 3 mo after treatment, but that number dropped to 24% 2 years after treatment. Eight of the 14 patients with recurrence after conservative treatment had surgery with no 30-d mortality.
  
  
  CONCLUSIONS
  Surgically-treated sigmoid volvulus patients had a higher long-term survival rate than conservatively managed patients, indicating a benefit of surgical resection or PEC insertion if feasible.
authors.affiliation: Anne Kathrine Wewer Ifversen, Daniel Willy Kjaer, Department of Surgery P, Aarhus University Hospital, 8000 Aarhus C, Denmark.
authors.forename: Anne Kathrine Wewer
authors.initials: AK
authors.lastname: Ifversen
authors.affiliation: Anne Kathrine Wewer Ifversen, Daniel Willy Kjaer, Department of Surgery P, Aarhus University Hospital, 8000 Aarhus C, Denmark.
authors.forename: Daniel Willy
authors.initials: DW
authors.lastname: Kjaer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects / Q000401:mortality; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003125:Colostomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003718:Denmark; D004630:Emergencies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D045822:Intestinal Volvulus / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012810:Sigmoid Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Percutaneous endoscopic colostomy; Recurrence; Resection; Sigmoid volvulus; Surgery