Department of Radiology, Ajou University School of Medicine, 206 Worldcup-ro, Yeongtong-gu, Suwon, 443-749, South Korea.
Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Eur Radiol. 2019 Oct;29(10):5723-5730. doi: 10.1007/s00330-019-06194-9. Epub 2019 Apr 26.
To determine which clinical or CT imaging factors can help accurately identify complicated sigmoid volvulus (SV), defined as irreversible bowel ischaemia or necrosis requiring emergent surgery in patients with SV.
We performed a retrospective study of 51 patients admitted consecutively to the emergency department for SV. All patients attempted endoscopic detorsion as the first treatment. Clinical and contrast-enhanced CT factors were analysed. A newly described dark torsion knot sign (sudden loss of mucosal enhancement in the volvulus torsion knot) was included as a CT factor. Patients were diagnosed with complicated versus simple SV based on either surgery or follow-up endoscopic findings. Univariate and multivariate analyses were used to identify predictors of complicated SV.
Of 51 study patients, 9 patients (17.6%) had complicated SV. Univariate analysis revealed that three clinical factors (sepsis, elevated C-reactive protein, and elevated lactic acid levels) and four CT factors (reduced bowel wall enhancement, increased bowel wall thickness, dark torsion knot sign, and diffuse omental infiltration) were significantly associated with complicated SV. Multivariate analysis identified only dark torsion knot sign (odds ratio = 104.40; p = 0.002) and sepsis (odds ratio = 16.85; p = 0.043) as independent predictive factors of complicated SV.
A newly defined CT imaging factor of dark torsion knot sign and a clinical factor of sepsis can predict complicated SV necessitating emergent surgery instead of colonoscopic detorsion as a primary treatment of choice.
• A newly defined CT imaging factor of dark torsion knot sign and a clinical factor of sepsis can be helpful for predicting complicated SV necessitating emergent surgery instead of endoscopic detorsion.
确定哪些临床或 CT 成像因素有助于准确识别复杂乙状结肠扭转（SV），即 SV 患者出现不可逆性肠缺血或坏死需要紧急手术。
我们对连续收治于急诊科的 51 例 SV 患者进行了回顾性研究。所有患者均尝试内镜复位作为一线治疗。分析了临床和增强 CT 因素。包括一个新描述的“暗扭转结征”（扭转结处黏膜增强突然消失）作为 CT 因素。根据手术或随访内镜结果，将患者诊断为复杂 SV 或简单 SV。采用单因素和多因素分析来确定复杂 SV 的预测因素。
51 例研究患者中，9 例（17.6%）发生复杂 SV。单因素分析显示，3 个临床因素（脓毒症、C 反应蛋白升高和乳酸水平升高）和 4 个 CT 因素（肠壁强化减弱、肠壁增厚、暗扭转结征和弥漫性网膜浸润）与复杂 SV 显著相关。多因素分析仅确定暗扭转结征（比值比=104.40；p=0.002）和脓毒症（比值比=16.85；p=0.043）是复杂 SV 的独立预测因素。
新定义的 CT 成像因素——暗扭转结征和临床因素——脓毒症可预测需要紧急手术的复杂 SV，而不是将结肠镜复位作为首选的一线治疗。
• 新定义的 CT 成像因素“暗扭转结征”和临床因素“脓毒症”有助于预测需要紧急手术的复杂 SV，而非内镜复位。
