title: Management of acute sigmoid volvulus: short- and long-term results.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France.
authors: M
authors: M
authors: Bruzzi
authors: Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France.
authors: J H
authors: JH
authors: Lefèvre
authors: Department of Gastroenterology and Endoscopy, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France.
authors: B
authors: B
authors: Desaint
authors: Department of Gastroenterology and Endoscopy, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France.
authors: I
authors: I
authors: Nion-Larmurier
authors: Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France.
authors: M
authors: M
authors: Bennis
authors: Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France.
authors: N
authors: N
authors: Chafai
authors: Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France.
authors: E
authors: E
authors: Tiret
authors: Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France.
authors: Y
authors: Y
authors: Parc
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods*; D012809:Colon, Sigmoid / Q000503:physiopathology / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods*; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D045822:Intestinal Volvulus / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult
keywords: Sigmoid volvulus; decompression; elderly; endoscopic colopexy; sigmoid resection