Timing in surgical management of acute volvulus of the sigmoid colon in geriatric patients

Background

The aim of this trial is to evaluate the importance of an early diagnosis and of a correct surgical timing in geriatric patients with sigmoid volvulus.

Materials and methods

We performed a retrospective analysis of all the patients treated for sigmoid volvulus at the Department of General and Emergency Surgery, S. Maria Hospital in Terni of the University of Perugia, from January 1996 to March 2008. We treated 23 patients with sigmoid volvulus; mean age was 81 years. Eleven patients were admitted with a diagnosis of intestinal occlusion, 12 patients came to us from Medical divisions.

Results

The best prognostic results were for the group whose diagnosis of sigmoid volvulus was precocious and the surgical indication was precociously given. In those cases with difficult diagnosis due to an unclear symptoms or patient's confounding factors or a negative abdominal plain film, the CT scan leaded us towards a correct diagnosis. The abdominal CT was performed only in 3 cases (8%) and its specificity was 100%. Perioperatory mortality was 38% in those patients treated without any sign of peritonism and 100% for patients with peritonitis.

Discussion

The clinical manifestation of a volvulus of the sigmoid colon is generally not clear at its onset and in a geriatric patient it can be even more confounding and the diagnosis can be achieved with difficulty. The instrumental exams (Abdominal plain film and CT) allow the identification of pathological signs in all cases of volvulus. The abdominal plain film shows the typical signs of mechanical ileus and the CT underlines the aspects related to the intestinal torsion.

Conclusion

The preoperative diagnosis of volvulus of the sigmoid colon can be quite difficult and it all can lead to a delay in the treatment. When the intervention is late the strangulation ileus will cause irreversible intestinal lesions. An early diagnosis is therefore fundamental and in geriatric patients who are often affected by more than one disease, the employment of a CT scan can be very useful.