Elective surgery after successful endoscopic decompression of sigmoid volvulus may be considered.

INTRODUCTION

Volvulus is an axial twist of any part of the gastrointestinal tract along its mesentery. If it goes unattended, it will cause bowel obstruction and bowel ischaemia with gangrene and perforation. The primary treatment is endoscopic desufflation, but the place for elective surgery is controversial. Volvulus is a rare condition in Western Europe and North America that most often affects elderly of either gender.

MATERIAL AND METHODS

We reviewed all records on patients admitted to our hospital during an 11-year period. Age at first admission, co-morbidity and number of readmissions were registered. The results of primary endoscopic treatment and any surgery were registered together with complications, 30-day and one-year moratality rates.

RESULTS

A total of 41 patients were treated. The mean age at first admission was 70 years. Significant co-morbidity was found in 33 patients (81%). Thirty patients (73%) were treated for recurrence. Fourteen patients were treated with decompression alone, and 27 patients were operated (14 acute and 13 elective cases). The 30-day mortality was 43% after acute operation and 8% after elective operation (p < 0.05). In the group of patients with decompression alone, the one-year mortality was 50%.

CONCLUSION

Elective surgery should be considered because of a high recurrence rate and one-year mortality after initially successful decompression.

FUNDING

not relevant.

TRIAL REGISTRATION

not relevant.