Department of General Surgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
Tech Coloproctol. 2013 Aug;17(4):419-24. doi: 10.1007/s10151-012-0953-z. Epub 2012 Dec 6.
Sigmoid volvulus (SV) is the wrapping of the sigmoid colon around itself and its mesentery. The goal of this study was to investigate the diagnosis approach to 938 patients with SV treated at our institution and their clinical outcomes.
The clinical records of 938 patients with SV treated at our institution between June 1966 and January 2012 were retrospectively reviewed.
The mean age was 58.6 years (range 10 weeks to 98 years), and 774 patients (82.5 %) were male. A total of 210 (25.1 %) of 837 patients, who provided information on anamnesis and clinical features, had recurrent episodes of volvulus; 215 patients (25.7 %) had comorbidities, and 108 patients (12.9 %) presented with toxic or hypovolemic shock. The mean duration of symptoms was 38.7 h (range 6 h to 7 days), and the most common clinical features were abdominal pain and tenderness (827 of 837 patients, 98.8 %), distention (805 patients, 96.2 %), and obstipation (771 patients, 92.1 %). The final diagnosis was made with endoscopy in 519 patients (55.3 %), endoscopy followed by surgery in 154 patients (16.4 %) and at surgery in 265 patients (28.3 %). The correct diagnosis rate was 71.6 % based on clinical findings compared with 66.7 % based on plain X-ray films, 81.4 % based on both clinical and plain X-ray findings, and 100.0 % based on CT or MRI findings.
Sigmoid volvulus is common in adult men. The disease is generally associated with recurrent episodes, comorbidity, and shock. SV generally presents as a large-bowel obstruction. Although plain X-rays may help with diagnosis, CT and MRI are more reliable diagnostic tools, and flexible endoscopy is always diagnostic. However, surgery is used to diagnose SV in limited situations.
乙状结肠扭转（SV）是乙状结肠及其系膜自身缠绕。本研究的目的是探讨我院收治的 938 例 SV 患者的诊断方法及其临床转归。
回顾性分析我院 1966 年 6 月至 2012 年 1 月收治的 938 例 SV 患者的临床资料。
患者的平均年龄为 58.6 岁（10 周龄至 98 岁），774 例（82.5%）为男性。210 例（25.1%）837 例有症状患者有反复发作的扭转病史；215 例（25.7%）有合并症，108 例（12.9%）有中毒性或低血容量性休克。症状持续时间平均为 38.7 小时（6 小时至 7 天），最常见的临床特征为腹痛和压痛（837 例患者中 827 例，98.8%）、腹胀（805 例，96.2%）和便秘（771 例，92.1%）。519 例（55.3%）患者最终诊断为内镜检查，154 例（16.4%）患者内镜检查后手术，265 例（28.3%）患者手术诊断。基于临床发现的正确诊断率为 71.6%，基于普通 X 线片的正确诊断率为 66.7%，基于临床和普通 X 线片的正确诊断率为 81.4%，基于 CT 或 MRI 的正确诊断率为 100.0%。
成人男性中乙状结肠扭转较为常见。该疾病通常与反复发作、合并症和休克有关。SV 通常表现为大肠梗阻。虽然普通 X 射线有助于诊断，但 CT 和 MRI 是更可靠的诊断工具，而软性内镜始终具有诊断价值。但是，在有限的情况下，手术用于诊断 SV。
