Optimal Treatment Of Sigmoid Volvulus

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Main Category: GastroIntestinal / Gastroenterology
Article Date: 25 Sep 2008 - 0:00 PDT

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An article published in the September 28, 2008 issue of the World Journal of Gastroenterology addresses the optimal surgical procedure to treat the age-old illness sigmoid volvulus. Sigmoid volvulus is a bowel obstruction in which a loop of bowel has twisted on itself in an abnormal fashion.

Although there currently is no consensus as to the best surgical method to treat an acute situation, physicians have used the approaches of resection, non-operative reduction using a colonoscope, sigmoidopexy, and mesosigmoidoplasty. For the past 200 years, resection and primary anastomosis (RPA) has become the most chosen treatment. This procedure, which requires the cutting out of a segment of intestine and the combining of two remaining ends, often leads to anastomotic leakage in the elderly and hemodynamically unstable (having difficulty moving blood) sigmoid volvulus patients. After emergency colorectal resection with intestinal anastomosis, the most important postoperative complication is symptomatic anastomotic leakage.

To further study the problem of symptomatic anastomotic leakage, a team of researchers led by Prof. Coban (Gaziantep University) and Prof. Kirimlioglu (Inonu University) prevented anastomotic leak using a modified proximal decompressive blow-hole colostomy. Previously, proximal decompressive blow-hole colostomy has been used in patients with toxic megacolon bowel disease (secondary to inflammatory) and clostridium difficile colitis with the intent of avoiding colon manipulation and to assist the patients through the critical phase of care. Since co-morbid risk factors are present, especially in those with gangrenous sigmoid volvulus, there are benefits that come adding a modified blow-hole colostomy in preventing anastomotic leak. In this study, the researchers compared results of RPA with or without modified blow-hole colostomy in unprepared bowel with acute sigmoid volvulus.

The study participants underwent RPA with or without modified blow-hole colostomy between March 2000 and September 2007. Of the 47 patients, 25 patients (Group A) received RPA the remaining 22 (Group B) received modified blow-hole colostomy with RPA. Anastomoses were inverting and two-layered in each patient.

The investigators found that group A was about four times as likely to develop superficial wound infection as group B - 32% to 9.1%, respectively. In addition, infection was about twice as common in patients with a viable colon. In group A, 12% of patients (3) developed anastomotic leak; zero patients in group B developed anastomotic leak. Finally, it took group A 3 days longer to resume diet than group B due to the protective stoma in group B.

The researchers conclude that the procedure, RPA with modified blow-hole colostomy in patients with sigmoid volvulus, is safe and effective in preventing anastomotic leak. Though further studies are needed to more robustly establish its role in sigmoid volvulus, the procedure may become the optimal method for patients with the condition.

Resection and primary anastomosis with or without modified blow-hole colostomy for sigmoid volvulus
Coban S, Yilmaz M, Terzi A, Yildiz F, Ozgor D, Ara C, Yologlu S, Kirimlioglu V
World Journal Gastroenterology (2008). 14(36): 5590-5594.
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Written by: Peter M Crosta
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