Management of acute sigmoid volvulus in a provincial centre-a 20-year experience.

AIM: At our institution there has been a long-standing early operative approach to large bowel volvulus as well as initial decompression with rigid sigmoidoscopy. The primary aim of this study was to investigate the safety and efficacy of this approach on reducing readmissions and complications. Secondary aims were to investigate the safety and efficacy of bedside rigid sigmoidoscopy in decompression of sigmoid volvulus and investigate the sensitivity of abdominal x-ray in the diagnosis of acute large bowel volvulus.

METHOD: A retrospective study was conducted on all patients presenting with acute obstruction due to large bowel volvulus between 1 January 1998-1 January 2018.

RESULTS: Thirty-four patients with acute sigmoid volvulus were identified that met the inclusion criteria with a median age of 81 years. The majority of patients 27/34 (79%) were booked for surgery on the first admission. Readmissions were reduced in the index operative group 1/20 (5%) vs the non-operative decompression group 3/4 (75%) RR 0.07 (CI 0.01-0.49 P=0.01).

CONCLUSION: Early sigmoid colectomy was associated with low morbidity and found to be safe in the elderly, and the results suggest that early surgery is associated with reduced readmissions and a low complication rate, with index surgery preferable to urgent elective surgery. Rigid sigmoidoscopy is a safe method of decompression as a bridge to index surgery and was not associated with any complications in this series.