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Objectives: Colonic volvulus is a common cause of bowel obstructions and surgery is the definitive treatment. Functional status is often associated with adverse postoperative outcomes but its effect on colectomy for volvulus remained under-explored. This study sought to analyze the effect of functional status on the 30-day outcomes of colectomy for volvulus., Materials and Method: National Surgical Quality Improvement Program (NSQIP) targeted colectomy database from 2012 to 2022 was utilized. Only patients with volvulus as the primary indication for colectomy were included. Thirty-day postoperative outcomes were compared between patients with dependent functional status (DFS) and independent functional status (IFS), adjusted for demographics, baseline characteristics, preoperative preparation, indication for surgery, and operative approaches by multivariable logistic regression., Results: There were 1,476 patients with DFS (945 partially DFS and 531 fully DFS) and 8,824 (85.67 %) IFS patients who underwent colectomy for volvulus. After multivariable analysis, DFS patients had higher risks of mortality (aOR=1.671, 95 CI=1.37-2.038, p < 0.01), pulmonary complications (aOR=2.166, 95 CI=1.85-2.536, p < 0.01), sepsis (aOR=1.31, 95 CI=1.107-1.551, p < 0.01), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (aOR=1.436, 95 CI=1.269-1.626, p < 0.01), discharge not to home (aOR=3.774, 95 CI=3.23-4.411, p < 0.01), and 30-day readmission (aOR=1.196, 95 CI=1.007-1.42, p = 0.04). Moreover, DFS patients had a longer length of stay (p = 0.01)., Conclusion: DFS was identified as an independent risk factor for increased mortality and complications after colectomy for volvulus. Given the substantial overlap between DFS patients and those who have colonic volvulus, these insights can contribute to preoperative risk assessments and postoperative care in these patients., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Data to guide surgical timing after colonic decompression for sigmoid volvulus are limited. Thus, we compared the postoperative outcomes of patients with sigmoid volvulus who underwent semielective (during index hospitalization after decompression) and elective surgery (subsequent elective hospitalization)., Methods: We performed a retrospective review of 100% Medicare Provider Analysis and Review Files from 2016 to 2019, including Medicare beneficiaries aged ≥65 years who were urgently/emergently admitted for their index episode of volvulus and underwent colonic decompression followed by surgery., Results: The mean age of 2,053 patients was 78 (standard deviation 8 years); 7% had elective surgery and 93% had semielective surgery (including 12.5% on the same day as decompression). In a bivariate analysis, elective surgery was associated with greater rates of minimally invasive surgery (32.8% vs 12.6%, P < .001), lower rates of ostomy formation (2.9% vs 36.0%, P < .001), and greater rates of discharge home (89.8% vs 47.4%, P < .001) with similar cumulative length of stay (8 vs 9 days, not significant) compared with semielective surgery. In a multivariable logistic regression, elective surgery was associated with reduced odds of morbidity (odds ratio, 0.60; 95% confidence interval, 0.49-0.74) and similar odds of mortality (odds ratio, 0.79; 95% confidence interval, 0.50-1.25) compared with semielective surgery, which remained consistent after excluding patients with surgery on the same day as decompression., Conclusions: After colonic decompression for sigmoid volvulus, elective surgery appears safe and is associated with favorable outcomes compared with semielective surgery. With the potential severe consequences of volvulus recurrence, these findings underscore the need for algorithms to predict recurrence risk to help guide careful patient selection for elective surgery., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Post-operative reflux (POR) is rare following large colon volvulus (LCV) but does occur despite the absence of a small intestinal lesion. The prevalence, risk factors and association with survival of POR after LCV are currently unknown., Objectives: To determine the prevalence of POR in horses with an LCV and its association with survival. A further objective was to assess factors which may predict POR. The hypothesis was that horses with POR following LCV surgery have a worse outcome for survival compared to those without POR., Study Design: A retrospective cross-sectional study., Methods: Clinical data of client owned horses which underwent colic surgery at a single UK referral hospital between 2008 and 2021, where LCV was the primary finding, were retrieved from hospital records. Statistical analyses included chi-squared, t-tests and odds ratios (ORs). Horses with concurrent lesions, and those that did not survive past anaesthetic recovery, were excluded from analysis. POR was defined as ≥2 L of gastric reflux on at least one occasion., Results: A total of 128 horses were included in the study, 23 of which had POR (18%). Overall survival to hospital discharge was 86%, 95% in the non-POR and 44% in the POR group. Horses with POR were less likely to survive to discharge than those without (OR = 26, 95% confidence interval [CI] [7.68-88.0], p < 0.001), and less likely to be alive 3 years after surgery (OR = 13.4, 95% CI [2.78-64.8], p < 0.001)., Main Limitations: Due to the retrospective study design, full data sets were not available for every case because clinical records were incomplete or, at that time, certain tests were not performed or clinical variables were not measured., Conclusions: POR in LCV cases is a negative prognostic indicator for survival., (© 2024 EVJ Ltd.)

Background: Bowel obstruction is a mechanical or functional blockade of intestinal contents from evacuation to the adjacent distal bowel or external environment. It poses significant morbidity and mortality in both high-income and low-to-middle-income countries. Ileosigmoid knotting is a special form of obstruction where the small bowel often ileum wraps around the sigmoid colon or vice versa. It is the severest form of bowel obstruction, involving both the small and large bowels in a compound manner. It is common where sigmoid volvulus is common and geographic areas with a bulky diet., Methods: An institution-based retrospective cohort study was employed among purposively selected 40 surgical patients with ileosigmoid knotting records from July 2020 to July 2023 at Jimma University Medical Center. To estimate and compare the survival probabilities, the Kaplan-Meir method and log-rank test were used. A Cox-regression analysis was fitted to identify independent predictors of time to death., Results: Among a cohort of 40 patients followed for 347 person-days at Jimma University Medical Center, 11 (27.5%) had died. The overall incidence rate of death was 3.2 (95% CI 1.8, 5.7) per 100 person-days. In multivariable Cox-regression analysis, age (AHR = 1.15; 95% CI: 1.04-1.28), shock at presentation (AHR = 30.50: 95% CI 1.25-742.54), comorbidities (AHR = 5.81; 95% CI 1.19-28.23), pulse rate intraoperatively (AHR = 1.19; 95% CI: 1.01-1.40), postoperative pulse rate (AHR = 1.07; 95% CI: 1.01-1.14) were independently associated with time to death., Conclusion: The incidence of death among surgical patients with ileosigmoid knotting was high and also had a shorter median survival time. Age, shock at presentation, comorbidities, pulse rate intraoperatively, and postoperative pulse rate were found to be statistically significant predictors of time to death and outcome among surgical patients with Ileosigmoid knotting., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Background: Gangrenous sigmoid volvulus has a significant impact on morbidity and mortality. This study was conducted to compare sigmoid resection and primary anastomosis (RPA) with sigmoid resection and end colostomy (Hartmann's procedure) for gangrenous sigmoid volvulus., Methods: A systematic review and meta-analysis study design was employed to summarize retrospective cohort, prospective cohort, and randomised control trial studies published from inception to march 31, 2023. Searching was performed on Medline, CINAHAL, Web of Science, Google Scholar, the Cochrane Library, and ClinicalTrials.gov to locate eligible articles. Data searching, selection and screening, quality assessment of the included articles, and data extraction were done by two separate reviewers. RevMan 5.4 software with a fixed-effect Mantel-Haenszel model and Stata version 14 were used to analyze the data. The protocol registered on PROSPERO registration website (CRD42023413367)., Results: Ten cohort studies and one randomised control trial with 724 patients were found; all of them were rated as being of moderate quality. The overall mortality after RPA was 15% (95%CI: 11-19%), and after Hartmann's procedure it was 19% (95%CI: 15-23%). Resection and primary anastomosis (RPA) for gangrenous sigmoid volvulus had slightly lower mortality rate than stoma (OR=0.98(95%CI: 0.68-1.42), p=0.07, I 2 =43%), which had no statistically significant difference. Resection and primary anastomosis (RPA) had a slightly higher morbidity rate than Hartmann's procedure (OR=1.01(95%CI: 0.66-1.55), p=0.30, I 2 =18%), which had no statistically significant difference., Conclusion: Sigmoid resection and primary anastomosis (RPA) and Hartmann's procedure had no significant differences in mortality and morbidity for the treatment of gangrenous sigmoid volvulus. Choice of the intervention for gangrenous sigmoid volvulus should be individualized with consideration of different detrimental factors., (© 2023 Atalel Fentahun Awedew, et al.)

Objective: To conduct a review of the literature on foetal volvulus with emphasis on prenatal imaging, pregnancy characteristics and clinical outcomes., Methods: A review of all published cases of foetal volvulus diagnosed prenatally and indexed in Medline, EBSCOhost, CINAHL, SOCIndex and Healthy Policy Reference Centre. Studies without antenatal sonographic signs of foetal volvulus and without a postpartum surgical diagnosis were excluded. Data were analysed for frequencies and distributions and tested for statistical significance., Results: Eighty-eight cases of foetal volvulus were identified from 58 published case reports/series. The most common ultrasound findings were dilated bowel/stomach (77.3%), polyhydramnios (30.7%) and whirlpool/snail sign (28.4%). Median gestation at diagnosis was 31.9 weeks (IQR 27-34) and mean gestation at delivery was 34.5 weeks (SD 2.8). Underlying aetiology included intestinal malrotation (15.9%), cystic fibrosis (14.8% of all cases, 32.5% of tested cases) and abnormal mesenteric fixation (12.5%). Complications included intestinal atresia (36.4%) and foetal anaemia (9.1%). The overall perinatal mortality rate was 14.5%., Conclusion: Foetal volvulus is a rare condition with high rates of preterm birth and perinatal mortality. Intestinal malrotation and cystic fibrosis are common predisposing causes, although the majority are idiopathic. Bowel and/or gastric dilatation is by far the most common sonographic finding., (© 2021 John Wiley & Sons Ltd.)

Objectives: Define clinical spectrum and long-term outcomes of gut malrotation. With new insights, an innovative procedure was introduced and predictive models were established., Methods: Over 30-years, 500 patients were managed at 2 institutions. Of these, 274 (55%) were children at time of diagnosis. At referral, 204 (41%) patients suffered midgut-loss and the remaining 296 (59%) had intact gut with a wide range of digestive symptoms. With midgut-loss, 189 (93%) patients underwent surgery with gut transplantation in 174 (92%) including 16 of 31 (16%) who had autologous gut reconstruction. Ladd's procedure was documented in 192 (38%) patients with recurrent or de novo volvulus in 41 (21%). For 80 patients with disabling gastrointestinal symptoms, gut malrotation correction (GMC) surgery "Kareem's procedure" was offered with completion of the 270° embryonic counterclockwise-rotation, reversal of vascular-inversion, and fixation of mesenteric-attachments. Concomitant colonic dysmotility was observed in 25 (31%) patients., Results: The cumulative risk of midgut-loss increased with volvulus, prematurity, gastroschisis, and intestinal atresia whereas reduced with Ladd's and increasing age. Transplant cumulative survival was 63% at 10-years and 54% at 20-years with best outcome among infants and liver-containing allografts. Autologous gut reconstruction achieved 78% and GMC had 100% 10-year survival. Ladd's was associated with 21% recurrent/de novo volvulus and worsening (P > 0.05) of the preoperative National Institute of Health patient-reported outcomes measurement information system gastrointestinal symptom scales. GMC significantly (P ≤ 0.001) improved all of the symptomatology domains with no technical complications or development of volvulus. GMC improved quality of life with restored nutritional autonomy (P < 0.0001) and daily activities (P < 0.0001)., Conclusions: Gut malrotation is a clinicopathologic syndrome affecting all ages. The introduced herein definitive correction procedure is safe, effective, and easy to perform. Accordingly, the current standard of care practice should be redefined in this orphan population., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Intestinal volvulus is a common cause of mechanical intestinal obstruction (MIO) in Africa. Sigmoid volvulus has been well characterized in both high-income and low-income countries, but there is also a predilection for small bowel volvulus in sub-Saharan Africa., Methods: An analysis was performed of the Kamuzu Central Hospital Acute Care Surgery Registry from 2013 to 2019 on patients presenting with intestinal volvulus. Bivariate analysis was performed for covariates based on the intestinal volvulus type. Multivariate Poisson regression models estimated the relative risk of volvulus and mortality., Results: A total of 4352 patients were captured in the registry. Overall, 1037 patients (23.8%) were diagnosed with MIO. Intestinal volvulus accounted for 499 (48.1%) of patients with MIO. Sigmoid volvulus, midgut volvulus, ileosigmoid knotting, and cecal volvulus accounted for 57.7% (n = 288), 19.8% (n = 99), 20.8% (n = 104), and 1.6% (n = 8), respectively. Mean age was 46.8 years (SD 17.2) with a male preponderance (n = 429, 86.0%) and 14.8% (n = 74) mortality. Overall, the most common operations performed were large bowel (n = 326, 74.4%) and small bowel (n = 76, 16.7%) resections with 18.0% (n = 90) ostomy formation. Upon regression modeling, the relative risk for volvulus was 2.7 times higher in men than women after controlling for season and age. There was no statistically significant difference in the relative risk of mortality based on the type of volvulus., Conclusion: Volvulus is a significant cause of primary bowel obstruction in sub-Saharan Africa. Type of intestinal volvulus is not associated increased risk of mortality. Reasons for increases in the incidence of small bowel volvulus are still largely undetermined.

Background: Adult midgut malrotation is a rare cause of an acute abdomen requiring urgent intervention. It may also present in the non-acute setting with chronic, non-specific symptoms. The objective of this study is to identify the clinical features, appropriate investigations and current surgical management associated with adult malrotation., Methods: A systematic review was conducted according to PRISMA guidelines, identifying confirmed cases of adult malrotation. Patient demographics, clinical features, investigation findings and operative details were analysed., Results: Forty-five reports met the inclusion criteria, totalling 194 cases. Mean age was 38.9 years (n = 92), and 52.3% were male (n = 130). The commonest presenting complaints were abdominal pain (76.8%), vomiting (35.1%) and food intolerance (21.6%). At least one chronic symptom was reported in 87.6% and included intermittent abdominal pain (41.2%), vomiting (12.4%) and obstipation (11.9%). Computerised tomography scanning was the most frequent imaging modality (81.4%), with a sensitivity of 97.5%. The whirlpool sign was observed in 30.9%; abnormalities of the superior mesenteric axis were the commonest finding (58.0%). Ladd's procedure was the most common surgical intervention (74.5%). There was no significant difference in resolution rates between emergency and elective procedures (p = 0.46), but length of stay was significantly shorter for elective cases. (p = 0.009). There was no significant difference in risk of mortality, or symptom resolution, between operative and conservative management (p = 0.14 and p = 0.44, respectively)., Conclusion: Malrotation in the adult manifests with chronic symptoms and should be considered as a differential diagnosis in patients with abdominal pain, vomiting and food intolerance.

Introduction: The primary study objective was to characterize the pattern of in-hospital mortality in dogs with gastric dilatation and volvulus (GDV), with a focus on preoperative nonsurvival., Materials and Methods: A retrospective review of medical records from a 10-year period was undertaken at a university teaching hospital. Data collected included signalment, physical examination parameters at hospital presentation, blood lactate concentration, and outcome., Results: A total of 498 dogs were included. Overall, 319 (64.1%) survived to discharge and 179 (35.9%) were nonsurvivors. Of the nonsurvivors, 149 (31.3% of all dogs) were euthanized and 30 (6%) died. Of those dogs euthanized, the majority (n = 116) were euthanized at the time of hospital presentation prior to surgery (ie, without intent to treat). When dogs that were euthanized prior to surgery were excluded, 83.5% of dogs survived to discharge. Median group age was higher in those euthanized than in the group of dogs that survived to discharge., Conclusions: Preoperative euthanasia and hence nonsurvival without intent to treat accounted for the majority of GDV mortality in this study. Given the high rate of nonsurvival without intent to treat it is likely that efforts focused at disease prevention will ultimately affect a much greater improvement in overall disease mortality than those focused on improving treatment., (© Veterinary Emergency and Critical Care Society 2020.)

Background: Data on outcomes after surgery for sigmoid volvulus is limited. The aim of this study was to develop a model to predict need for emergent surgery and mortality after resection for sigmoid volvulus., Methods: The NSQIP database was queried from 2012 to 2016 to identify patients undergoing segmental resection for sigmoid volvulus. Pre-, intra-, and post-operative variables were compared. Primary and secondary outcomes were emergent surgery and risk of mortality, respectively. Chi-square and Fischer's test for categorical variables and the Mann-Whitney test for continuous variables were used. Significant variables for each outcome were entered into a logistic regression model to predict the outcomes., Results: 2086 patients met inclusion criteria. Factors associated with emergency surgery included female gender, relative hematocrit elevation, relative leukocytosis, acute kidney injury, preoperative sepsis, prior functional independence, and bleeding disorders. Laparoscopic resection and mechanical bowel preparation were more commonly used in the nonemergent setting. Patients having emergent resection were more likely to suffer from postoperative superficial surgical site infection, pneumonia, cardiac arrest, septic shock, myocardial infarction, and receive perioperative transfusion. No difference was seen in ileus, readmission or reoperation rates in the emergent and nonemergent groups. Factors predictive of postoperative mortality included increased age, systemic sepsis, and emergent surgery. Independence before illness, higher albumin levels, and lower BMI were shown to be protective., Conclusions: Emergent resection is independently associated with poor postoperative outcomes and mortality. Predictors of need for emergent resection and mortality identified in this study can be used to aid in shared decision-making for patients with sigmoid volvulus., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Sigmoid volvulus is the commonest cause of large bowel obstruction in many regions of the world. Its prevalence varies greatly geographically. In Ethiopia, the disease is the commonest cause of emergency admissions due to intestinal obstruction. However, few studies have been conducted discussing the management outcome in Ethiopia and Africa. This research was conducted to assess the pattern & management outcome of acute sigmoid volvulus at a district hospital in South-west Ethiopia., Methods: A facility based retrospective cross-sectional review of surgical records was done to identify patients who had acute sigmoid volvulus. Data was collected using structured questionnaire by three pre trained data collectors. The collected data was checked for its completeness, and then entered, edited, cleaned and analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0. For all statistical significance tests the cut-off value set was P < 0.05., Result: A total of 131 patients were managed for acute sigmoid volvulus. 108 (82.4%) were men with a male to female ratio of 4.7:1. The hospital prevalence of acute sigmoid volvulus was 27.9%. Majority (42%) of the patients were in the 6th decades of life. Abdominal pain, abdominal distention & inability to pass feces & flatus were the predominant presenting compliant while abdominal distention was the dominant physical finding in all of the patients. Ninety-seven patients (74%) had viable bowel obstruction of which 29 patients had successful rectal tube deflation. The remaining 68 patients were managed operatively by either primary resection & anastomosis (62 patients) or derotation alone (6 patients). Thirty-four patients had gangrenous bowel obstruction and were managed by either primary resection and anastomosis (16 patients) or Hartman's colostomy (18 patients). Six patients died of which 5 had primary resection and anastomosis (2 for viable and 3 for gangrenous bowel obstruction).The predominant postoperative complication was wound infection in 11(10.7%) patients. Factors associated with unfavorable outcome were female sex, primary resection & end to end anastomosis and presentation of illness more than 24 h., Conclusion: The most common management was primary resection and anastomosis. The overall mortality rate was 4.5% and the mortality rate related to primary resection and end to end anastomosis was 6.4%. Mortality rate was higher in those patients who had resection and anastomosis for gangrenous bowel compared to those who had viable bowel (19% vs 3%). Generally factors associated with poor outcome were duration of illness, primary resection and anastomosis and being female.

Heterotaxy syndrome (HS) is a significant determinant of outcome in single ventricle (SV) physiology. Attrition rate and time-related events associated with intestinal malrotation (IM) are, yet, to be determined. We sought to evaluate hospital and interstage outcomes in relation with operative intervention for IM (IMO). Twelve SV/HS patients, who underwent IMO, from January 2004 to December 2016, were studied. Early shunt failure, time to superior cavopulmonary connection (SCPC) and interstage attrition were assessed. Since September 2014, based on a comprehensive standardized protocol, IMO was performed at the time of hospitalization for stage-I palliation (S1P) irrespective of clinical manifestations. Patients were assigned to Group A (n = 8): expectant /symptoms-driven versus Group B (n = 4): protocol-driven. At S1P 7 had systemic-to-pulmonary shunt (SPS), 1 SPS with anomalous pulmonary venous return (APVR) repair (Group A) compared to 2 SPS, 1 SPS with APVR repair and 1 Norwood operation (Group B). Median duration from S1P to IMO was 82 days (range 57-336; Group A) compared to 14 days (range 11-31; Group B); p < 0.05. Median age at IMO was 87 days (range 8-345) [Group A: 99 days (range 68-345) vs Group B: 25 days (range 8-39)] (p < 0.05). Early SPS failure occurred in 25% (2 of 8) for Group A compared to none in Group B (p < 0.05). Hospital mortality following IMO was 25% [Group A: 37.5% (3 of 8) vs Group B: 0; p < 0.05]. Interstage survival was 67% [Group A: 50% (4 of 8) vs Group B: 100%; p < 0.05]. Time to SCPC following S1P was 186 days (range 169-218) for Group A compared to 118 days (range 97-161) (Group B); p < 0.05. Operative intervention for IM in SV/HS is associated with significant interstage attrition and might impact the time to SCPC. SPS is at risk for early failure after IMO. A comprehensive standardized concept can mitigate detrimental implications.

Background: Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery., Aim: The aim of this study was to compare death rate between elective sigmoidectomy and conservative management following endoscopic detorsion for sigmoid volvulus., Methods: The medical records of 83 patients undergoing endoscopic detorsion of a sigmoid volvulus from 2008 to 2014 were retrospectively reviewed. Patients were divided into two groups: 'elective surgery' and 'no surgery'., Results: Patients in the 'no surgery' group (n = 42) were older and had more loss of autonomy than in the 'elective surgery' group. Volvulus endoscopic detorsion was successful in 96% of patients with no complications. The median follow-up was 13 months (1 day-67 months). The death rate was 62% in the 'no surgery' group versus 32% in the 'elective surgery' group (p = 0.02). In the 'no surgery' group, 23/42 of patients had volvulus recurrence. No recurrence occurred after surgery., Conclusion: Elective surgery must be planned as soon as possible after the first episode of sigmoid volvulus. In frail patients, other options must be developed., (Copyright © 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Backround Sigmoid volvulus is an uncommon cause of bowel obstruction in most western societies. Treatment options include colonoscopy in uncomplicated disease with elective surgery later on. The aim of this study was to assess what treatment sigmoid volvulus patients receive along with long-term outcomes at Landspitali University Hospital. Methods The study was retrospective. Patients diagnosed with sigmoid volvulus at Landspitali University Hospital from 2000-2013 were included. Information regarding age, sex, and duration of hospital stay, treatment, short and long-term outcomes were gathered. Results Forty-nine patients were included in the study, of which 29 men and 20 women. Mean age was 74 (25-93). One patient underwent acute surgery on first arrival due to signs of peritonitis. Others (n=48) were treated conservatively in the first attempt with colonoscopy (n=45), barium enema (n=2) and rectal tube (n=1). Three other patients underwent acute surgery due to failed colonoscopy, 8 patients had planned surgery during the index admission. Thirty-six patients were discharged after conservative treatment with colonoscopy (n=35), barium enema (n=1) or rectal tube (n=1). Two patients came in for elec-tive surgery later on. Twenty-two patients (61%) had recurrence. Median time to recurrence was 101 days (1-803). Disease-free probability in 3, 6 and 24 months was 66%, 55% and 22% respec-tively. Total disease related mortality was 10.2%. Mortality (30 days) after acute surgery was 25% (1/4) and 16,6% (3/18) after planned surgery. Conclusions Sigmoid volvulus has high recurrence rate if not treated operatively. Total mortality due to sigmoid volvulus at Landspitali is low but surgery related mortality high.

Objective: Intestinal malrotation classically presents in the neonatal period with bilious vomiting. However, population studies suggest that up to two-thirds of these patients are diagnosed later in childhood or in adulthood. Increased morbidity in the adult population has been reported. Local experience suggested that surgery was technically more difficult in older children and led to the hypothesis that it would be associated with increased morbidity., Methods: A retrospective case note analysis was performed on all children presenting with intestinal malrotation to a tertiary referral center between January 2002 and November 2014. Case notes and operation records were reviewed and those who underwent laparotomy for confirmed malrotation were included. Children were grouped as infants (< 1 year) and older (> 1 year). The primary outcome was total emergency reoperation rate. Secondary outcomes were requirement for a bypass at reoperation and mortality., Results: A total of 131 children with malrotation were identified (104 infants, 27 older children; 78 males; age range, 0-16 years). Overall, 13 patients had emergency reoperation following initial Ladd procedure (6 infants and 7 older children). Risk for reoperation was significantly higher in older children (p = 0.005) and additionally a bypass procedure was more often required in older children than infants (4 children, 2 infants, p = 0.016). Adhesiolysis was required on four occasions and redo Ladd procedure in two; these were evenly distributed between both groups. One child was found to have distal bowel obstruction at reoperation. There were three deaths (2.3%), all in the infant group. One was directly associated with malrotation with extensive bowel necrosis. The other two died of unrelated sepsis several months later., Conclusions: Malrotation surgery in older children is associated with a significantly higher emergency reoperation rate. The primary duodenal bypass procedure should always be considered with longstanding chronic intermittent obstruction associated with malrotation if the simple Ladd procedure is deemed inadequate., (Georg Thieme Verlag KG Stuttgart · New York.)

Aim: The best form of prophylactic management of a decompressed sigmoid volvulus (SV) is controversial especially in the elderly. We have studied our experience with this condition to assess the short- and long-term results of SV management., Method: All patients treated for SV in our department between 2003 and 2013 were retrospectively included. Emergency decompression was attempted in all patients in whom there was no sign of peritonitis. Planned surgical resection was the procedure of choice in young patients. Percutaneous endoscopic colopexy (PEC) was used in high surgical risk patients., Results: There were 65 patients (45 males) of median age 71.5 (24-99) years. Non-surgical reduction was performed in 62 with a success rate of 95% (59/62). Recurrence after initial decompression was 67% at a median follow-up of 5 (1-14) years. A prophylactic surgical resection was performed with primary anastomosis in 33 patients. There were no deaths and the major morbidity rate was 6%. At a mean follow-up of 62 months, only 1 (3%) patient had had a recurrence (at 130 months). PEC was performed in six patients of median age 90 (84-99) years and with a median American Society of Anesthesiologists score of 4. Complications included local site infection (n = 2), pain (n = 1) and abdominal wall bleeding (n = 1). After a median follow-up of 2 (1-4) years, three patients died from medical causes and one recurrence occurred 13 months after removal of the PEC tube., Conclusion: Prophylactic treatment after initial decompression of SV results in a low rate of recurrence. Planned sigmoid resection is safe and effective. In frail elderly patients, PEC is satisfactory., (Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.)

Purpose: The purpose of the study was to determine the proportion of pediatric deaths investigated by HM Coronial autopsy which were potentially preventable deaths due to treatable natural disease, and what implications such findings may have for health policies to reduce their occurrence., Methods: A retrospective study of 1779 autopsies of individuals between 7 days and 14 years of age requested by HM Coroner, taking place in one specialist pediatric autopsy center, was undertaken. Cases were included if they involved a definite natural disease process in which appropriate recognition and treatment was likely to have affected their outcome. Strict criteria were used and cases were excluded where the individual had any longstanding condition which might have predisposed them to, or altered the recognition of, acute illness, or its response to therapy., Results: Almost 8% (134/1779) of the study group were potentially preventable deaths as a result of natural disease, the majority occurring in children younger than 2 years of age. Most individuals reported between 1 and 7 days of symptoms before their death, and the majority had sought medical advice during this period, including from general practitioners within working hours, and hospital emergency departments. Of those who had sought medical attention, around one-third had done so more than once (28%, 15/53). Sepsis and pneumonia accounted for the majority of deaths (46 and 34% respectively), with all infections (sepsis, pneumonia and meningitis) accounting for 110/134 (82%)., Conclusion: Around 10% of pediatric deaths referred to HM Coroner are potentially preventable, being the result of treatable natural acute illnesses. In many cases medical advice had been sought during the final illness. The results highlight how a review of autopsy data can identify significant findings with the potential to reduce mortality, and the importance of centralized investigation and reporting of pediatric deaths.

Background: This is a single-center case series about the rare condition of volvulus without malposition and/or malrotation (VWM) in preterm babies. We focus on diagnostic difficulties, and our results should help to distinguish VWM as a distinct entity different from classical volvulus and segmental volvulus., Materials and Methods: Medical chart review of infants with VWM from 2003-2012 was used., Results: A total of 15 patients were identified. All of them had volvulus in the absence of intestinal malposition or other associated intestinal pathologies. All patients were born prematurely. Emergency laparotomy was necessary in all 15 patients. Two groups were identified. Group 1 includes four patients with typical signs of meconium obstruction of prematurity (MOP). Small bowel resection was only necessary in one of these four patients, all survived without residual intestinal lesions. Group 2 consists of 11 patients without signs of MOP-small bowel resection and temporary enterostomy were necessary in all these children. Four patients presented with pneumatosis intestinalis on the abdominal plain film, suggesting necrotizing enterocolitis. Although two infants died, the survivors showed complete recovery., Conclusions: VWM is a distinct disease of prematurity. When associated with MOP, VWM has a favorable outcome of treatment. In contrast, VWM occurring in the absence of signs of meconium obstruction requires small bowel resection. VWM primarily affects the top of the midgut (ileum). Because of absent malposition, presentation of VWM may be uncharacteristic. Pneumatosis intestinalis in advanced VWM may lead to diagnostic difficulties and a delay in treatment., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Aim: To assess the outcome of patients treated conservatively vs surgically during their first admission for sigmoid volvulus., Methods: We conducted a retrospective study of 61 patients admitted to Aarhus University Hospital in Denmark between 1996 and 2011 for their first incidence of sigmoid volvulus. The condition was diagnosed by radiography, sigmoidoscopy or surgery. Patients treated with surgery underwent either a sigmoid resection or a percutaneous endoscopic colostomy (PEC). Conservatively treated patients were managed without surgery. Data was recorded into a Microsoft Access database and calculations were performed with Microsoft Excel. Kaplan-Meier plotting and Mantel-Cox (log-rank) testing were performed using GraphPad Prism software. Mortality was defined as death within 30 d after intervention or surgery., Results: Among the total 61 patients, 4 underwent emergency surgery, 55 underwent endoscopy, 1 experienced resolution of the volvulus after contrast enema, and 1 died without treatment because of large bowel perforation. Following emergency treatment, 28 patients underwent sigmoid resection (semi-elective n = 18; elective n = 10). Two patients who were unfit for surgery underwent PEC and both died, 1 after 36 d and the other after 9 mo, respectively. The remaining 26 patients were managed conservatively without sigmoid resection. Patients treated conservatively on their first admission had a poorer survival rate than patients treated surgically on their first admission (95%CI: 3.67-14.37, P = 0.036). Sixty-three percent of the 26 conservatively treated patients had not experienced a recurrence 3 mo after treatment, but that number dropped to 24% 2 years after treatment. Eight of the 14 patients with recurrence after conservative treatment had surgery with no 30-d mortality., Conclusion: Surgically-treated sigmoid volvulus patients had a higher long-term survival rate than conservatively managed patients, indicating a benefit of surgical resection or PEC insertion if feasible.

Aim of the Study: The optimal treatment for acute sigmoid volvulus has not been defined. Our aim was to compare the results of two techniques for the management of uncomplicated sigmoid volvulus coming from two separate surgical services, which had each chosen a different technique: open surgical versus laparoscopic., Patients and Methods: Patients with sigmoid volvulus who underwent a surgical resection with immediate anastomosis, either emergency or scheduled, were included. Risk of morbidity (Dindo-Clavien criteria) and mortality (criteria of the AFC-French Association of Surgery) were evaluated., Results: Thirteen patients in the open surgical group were operated in a 10-year period and 17 patients in the laparoscopy group were operated on in a seven-year period. The mean age (57 years in both groups) and sex ratio (0.7 versus 0.6, respectively), and the length of hospital stay (18 versus 15 days, respectively) were comparable in the two groups. The open surgical procedure was performed urgently in 62% (n=8/13) versus 24% (n=4/17) in the laparoscopic group. The two groups were comparable in terms of risk factors for mortality by AFC score. The anastomotic leak rate was 8% (n=1/13) for the open surgical group versus 18% (n=3/17) for the laparoscopic group, while serious morbidity was 15% (n=2/13) versus 12% (n=2/17). No recurrence of volvulus was observed in the open group (mean follow-up of 26 months) versus 12% (n=2) in the laparoscopy group (mean follow-up of 32 months)., Conclusion: We did not find any significant difference between the two techniques. But the technical simplicity and the absence of recurrence in the open surgical group emphasize the importance of this technique., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: Prognosis of midgut volvulus in neonates and infants younger than 1 year remains poor, as diagnostic findings may not be apparent until gut infarction had occurred. To characterize factors that help to predict complex midgut volvulus early was aim of this study., Methods: Institutionally approved retrospective analysis of all children younger than 1 year treated for midgut volvulus at the author's center from January 2002 to December 2011. Medical history, symptoms, laboratory and radiologic findings as well as sequelae of midgut volvulus were evaluated., Results: In 10 years, 37 children fulfilled the inclusion criteria. Of these, 43% developed complications, and mortality rate was 16%. In 30% of the patients, the only clinical sign was a sudden worsening of the general condition and abdominal distension (complex 19% vs. simple 38%). In one child with simple midgut volvulus, all clinical, laboratory and radiologic signs were negative. CART analysis identified a base excess below -1.70 and preterm birth (<36 weeks) as the best discriminators of complex and simple midgut volvulus. A score >1pt (comprised of these two factors) was found in all children with complex and in 14% of simple midgut volvulus (p < 0.001). A positive score (>1pt) offers a sensitivity of 100% (81.7-100%), specificity of 85.7% (71.8-85.7%), a PPV of 84.2% (68.8-84.2%) and NPV 100% (83.8-100%)., Discussion: The study shows that midgut volvulus has a substantial morbidity and mortality. Unfortunately, not all affected children get picked up by history, laboratory and imaging. However, the proposed score helps to identify subject with increased risk of complications. It has the potential to facilitate and accelerate diagnosis of complex midgut volvulus; ultimately, it might help to reduce morbidity and mortality.

Objective: The aim was to evaluate the results of surgical treatment of occlusion of the sigmoid colon due to volvulus., Patients and Methods: This was a retrospective study from 1996 to 2010 of all patients undergoing surgery for sigmoid volvulus in surgical wards of the University Hospital of Bamako., Results: A total of 417 patients were identified including 379 men and 38 women. The mean patient age was 45.7 ± 18.3 years. The general condition of the patients was good in 70.5% and altered in 29.5% of cases. Colonic necrosis was present in 80 patients (19.2%). Single-stage resection with immediate anastomosis was performed in 149 patients (35.73%). Two-stage surgery was performed in 268 cases (64.27%). The initial stage of the two-stage procedure was colostomy in 167 cases and simple detorsion in 101 cases. The surgical approach had an impact on mortality in patients who were in poor general condition. Single-stage surgery resulted in higher mortality (12/149; 8.05%) than two-stage surgery (5/268; 1.87%), and the difference was statistically significant (P=0.0005)., Conclusion: Single-stage surgery for sigmoid volvulus carries a high risk of death when it is performed in patients with poor general condition. Indications for surgery must take into account the patient's general condition and the viability of the torsed sigmoid colon., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: Colonic volvulus is a rare entity associated with high mortality rates. Most studies come from areas of high endemicity and are limited by small numbers. No studies have investigated trends, outcomes, and predictors of mortality at the national level., Methods: The Nationwide Inpatient Sample 2002-2010 was retrospectively reviewed for colonic volvulus cases admitted emergently. Patients' demographics, hospital factors, and outcomes of the different procedures were analyzed. The LASSO algorithm for logistic regression was used to build a predictive model for mortality in cases of sigmoid (SV) and cecal volvulus (CV) taking into account preoperative and operative variables., Results: An estimated 3,351,152 cases of bowel obstruction were admitted in the United States over the study period. Colonic volvulus was found to be the cause in 63,749 cases (1.90%). The incidence of CV increased by 5.53% per year whereas the incidence of SV remained stable. SV was more common in elderly males (aged 70 years), African Americans, and patients with diabetes and neuropsychiatric disorders. In contrast, CV was more common in younger females. Nonsurgical decompression alone was used in 17% of cases. Among cases managed surgically, resective procedures were performed in 89% of cases, whereas operative detorsion with or without fixation procedures remained uncommon. Mortality rates were 9.44% for SV, 6.64% for CV, 17% for synchronous CV and SV, and 18% for transverse colon volvulus. The LASSO algorithm identified bowel gangrene and peritonitis, coagulopathy, age, the use of stoma, and chronic kidney disease as strong predictors of mortality., Conclusions: Colonic volvulus is a rare cause of bowel obstruction in the United States and is associated with high mortality rates. CV and SV affect different populations and the incidence of CV is on the rise. The presence of bowel gangrene and coagulopathy strongly predicts mortality, suggesting that prompt diagnosis and management are essential.

Objective: To describe the management of sigmoid volvulus with reference to the type of surgical procedures performed and to determine the prognosis of sigmoid volvulus., Study Design: A case series., Place and Duration of Study: Ghaem Hospital of Mashhad, University of Medical Sciences, Mashhad, Iran, from 1996 to 2008., Methodology: A total of 944 cases of colon obstruction were reviewed. Demographic, laboratory and treatment results, mortality and complications were recorded. The data was analyzed using descriptive statistics as frequency and percentage for the qualitative variables and mean and standard deviation values for the quantitative variables. Also chisquare and Fisher's exact test were used for the association between the qualitative variables. SPSS statistical software (version 18) was used for the data analysis., Results: In all patients except those with symptoms or signs of gangrenous bowel, a long rectal tube was inserted via the rectosigmoidoscope which was successful in 80 (36.87%) cases. Rectosigmoidoscopic detorsion was unsuccessful in 137 (63.13%) patients, who underwent an emergent laparotomy. The surgical procedures performed in these cases were resection and primary anastomosis in 40 (29.1%), Mikulicz procedure in 9 (6.6%), laparotomy detorsion in 37 (27.01%), Hartmann procedure in 47 (34.3%), mesosigmoidoplasty in 3 (2.19%) patients and total colectomy in one (0.73%) case. The overall mortality was 9.8% (22) patients., Conclusion: In sigmoid volvulus, the most important determinant of patient outcome is bowel viability. The initial treatment of sigmoid colon volvulus is sigmoidoscopy with rectal tube placement.

Aim: To investigate an appropriate strategy for the treatment of patients with acute sigmoid volvulus in the emergency setting., Methods: A retrospective review of 28 patients with acute sigmoid volvulus treated in the Department of Colorectal Surgery, Changhai Hospital, Shanghai from January 2001 to July 2012 was performed. Following the diagnosis of acute sigmoid volvulus, an initial colonoscopic approach was adopted if there was no evidence of diffuse peritonitis., Results: Of the 28 patients with acute sigmoid volvulus, 19 (67.9%) were male and 9 (32.1%) were female. Their mean age was 63.1 ± 22.9 years (range, 21-93 years). Six (21.4%) patients had a history of abdominal surgery, and 17 (60.7%) patients had a history of constipation. Abdominal radiography or computed tomography was performed in all patients. Colonoscopic detorsion was performed in all 28 patients with a success rate of 92.8% (26/28). Emergency surgery was required in the other two patients. Of the 26 successfully treated patients, seven (26.9%) had recurrent volvulus., Conclusion: Colonoscopy is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus. Emergency surgery is only for patients in whom nonoperative treatment is unsuccessful, or in those with peritonitis.

Intestinal volvulus was recognized as the cause of death in 18 cetaceans, including 8 species of toothed whales (suborder Odontoceti). Cases originated from 11 institutions from around the world and included both captive (n = 9) and free-ranging (n = 9) animals. When the clinical history was available (n = 9), animals consistently demonstrated acute dullness 1 to 5 days prior to death. In 3 of these animals (33%), there was a history of chronic gastrointestinal illness. The pathological findings were similar to those described in other animal species and humans, and consisted of intestinal volvulus and a well-demarcated segment of distended, congested, and edematous intestine with gas and bloody fluid contents. Associated lesions included congested and edematous mesentery and mesenteric lymph nodes, and often serofibrinous or hemorrhagic abdominal effusion. The volvulus involved the cranial part of the intestines in 85% (11 of 13). Potential predisposing causes were recognized in most cases (13 of 18, 72%) but were variable. Further studies investigating predisposing factors are necessary to help prevent occurrence and enhance early clinical diagnosis and management of the condition.

Reasons for Performing Study: The pattern of long-term survival and specific factors associated with long-term survival have not previously been evaluated in horses with a strangulating large colon volvulus (LCV)., Objectives: To provide data on the long-term survival of horses with LCV and to identify pre-, intra- and post operative variables associated with survival., Methods: Clinical data and long-term follow-up information were obtained from 116 horses with a strangulating LCV (≥360°) undergoing general anaesthesia. Two multivariable Cox proportional hazards models for post operative survival time were developed: Model 1 included all horses and evaluated preoperative variables and Model 2 included horses that survived anaesthesia and evaluated pre-, intra- and post operative variables., Results: The study population comprised 116 horses. Eighty-nine (76.7%) survived general anaesthesia. Of these, the percentage that survived until discharge, to one year and to 2 years was 70.7%, 48.3% and 33.7%, respectively. Median survival time for horses that survived general anaesthesia was 365 days. In Model 1 increased preoperative packed cell volume (PCV) was significantly associated with reduced post operative survival (hazard ratio [HR] 1.08, 95% confidence interval [CI] 1.05-1.11). However, this effect changed over time. In Model 2 abnormal serosal colour intraoperatively (HR 3.61, 95% CI 1.55-8.44), increased heart rate at 48 h post surgery (HR 1.04, 95% CI 1.02-1.06), and colic during post operative hospitalisation (HR 2.63, 95% CI 1.00-6.95), were all significantly associated with reduced post operative survival., Conclusions: Survival time in horses with a LCV was associated with preoperative PCV, serosal colour, heart rate at 48 h post operatively and colic during post operative hospitalisation., Potential Relevance: This study provides evidence-based information on the long-term survival of horses with LCV and identifies parameters that may assist decision-making by clinicians and owners., (© 2012 EVJ Ltd.)

Introduction: Sigmoid volvulus is an important acute intestinal obstruction, leading to high mortality and requiring urgent operation. The purpose of this study is to analyze risk factors for mortality in patients that were operated on due to sigmoid volvulus at our Department., Materials and Methods: The retrospective study included 158 patients, who were operated on due to sigmoid volvulus between January 1994-December 2010, in terms of age, gender, complaints at admission, physical signs, period of symptoms before admission, associated diseases, laboratory and radiological parameters, hospital stay, morbidity, and mortality., Results: The study consisted of 135 men (85.4%) and 23 women (14.6%), with a mean age of 62.54 years. Cardiovascular disease and respiratory disease were present in 34 (21.5%) and 42 (26.6%) patients, respectively. Urgent operation was undertaken in 125, while 33 received elective surgery. Abdominal distension and pain was evident in all the patients. Generalized tenderness was detected in 58.2%, while 70.9% had hyperactive bowel sound with tympanism. Plain radiograph revealed an impression of "omega ans" in all patients, while free air was detected in 11.4% of them. Risk factors for mortality included age (p = 0.008), delayed admission (p = 0.001), cardiovascular and respiratory diseases (p = 0.001), fluid-electrolyte imbalance (p =0.001), presence of necrosis (p = 0.001), and major contamination (p = 0.001). Wound infection and intraabdominal abscess were more common in patients that developed mortality (p = 0.001 and p = 0.002)., Conclusions: Complications like wound infection and intraabdominal abscess are more frequent in the patients with the risk of mortality. Delayed admission results in higher risk of mortality. Mortality rates can be reduced by early admission, preoperative intensive resuscitation, suitable antibiotics, and emergent and viable surgery.

Introduction: Sigmoid volvulus typically occurs in older patients who have multiple co-morbidities. Therefore, often, a conservative approach to management is chosen. However, there is little data on long-term outcomes of this approach in Australasia. The aim of this study was to review the recurrence and mortality outcomes of patients admitted to Dunedin Hospital with sigmoid volvulus., Methods: All cases of sigmoid volvulus admitted to the Department of General Surgery at Dunedin Hospital from January 1989 to January 2009 were identified using a prospective database, the Otago Clinical Audit. Mortality data was accessed from the National Births and Deaths Registry., Results: Fifty-seven patients, median age of 68, were included in the study with 84 admissions for sigmoid volvulus. A total of 39 of the 57 patients ultimately had surgery, 26 on the index admission. Thirty-one patients (61%) treated conservatively at index admission had a recurrence at a median of 31 days. Forty-two per cent of the patients treated conservatively a second time suffered a further recurrence at a median of 144 days. There was no recurrence in patients who had surgery. There was no in-hospital mortality reported in either group. There was one anastomotic leak in the surgical group. Minor complications included ileus, respiratory infections, urinary tract infection and a hernia., Conclusion: Early elective operation for cases of sigmoid volvulus is encouraged in patients without prohibitive co-morbidities as this study shows a high recurrence rate in conservatively managed patients and a low morbidity and mortality in surgically managed patients., (© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.)

Objective: To (1) determine if histologic scores of pelvic flexure biopsies can predict short-term survival in horses with large colon volvulus (LCV) and (2) identify clinical variables predictive of short-term survival., Study Design: Case series., Animals: Horses (n = 28) with LCV (≥ 360°)., Methods: Medical records (January 2000-February 2008) of 28 horses were reviewed and clinical data recorded. Pelvic flexure biopsies were reviewed by 2 board-certified veterinary pathologists, unaware of clinical history and outcome, using 2 scoring systems. Exact logistic regression analysis was used to determine the relationship between histopathology scores (tissue viability), clinical data, and short-term survival (hospital discharge)., Results: Twenty-four horses (86%) survived to hospital discharge. Using a similar cutoff, neither scoring system was capable of predicting short-term survival. One scoring system failed to correctly predict clinical outcome in 5/25 horses (20%) and the other failed in 6/28 horses (22.4%). Heart rate (at admission and 24 hours after surgery) and packed cell volume 24 hours after surgery were significantly associated with short-term survival., Conclusion: Histopathologic evaluation of pelvic flexure biopsies did not accurately predict short-term survival in a significant proportion of horses with LCV in this study., (© Copyright 2012 by The American College of Veterinary Surgeons.)

Sigmoid volvulus is a serious surgical emergency and a common cause of large bowel obstruction in India. Patients present with abdominal pain, distension and obstipation and abdominal skiagram usually reveals the characteristic omega sign. Non-operative detorsion with early elective sigmoidectomy is the procedure of choice where gut viability is not in doubt and features of peritonitis are absent. The objective of this study was to demonstrate the most suitable procedure for management of patients with sigmoid volvulus needing emergency surgery. Results revealed a high incidence of burst abdomen and anastomotic leak as well as a high mortality rate in patients undergoing resection with primary anastomosis without proximal colostomy. Mortality was least with Hartmann's procedure although there was a higher incidence of wound infection. Thus, in the hospital setting, we consider Hartmann's procedure to be the best emergency surgical procedure for sigmoid volvulus as it limits mortality to the least.

An adult female dugong (Dugong dugon) was found dead and floating in Moreton Bay, Queensland, Australia. This animal was found to have a 360° mesenteric volvulus with infarction of the associated segment of small intestine, and fibrinous peritonitis. Mortality was attributed to the volvulus and its sequelae. The cause was not apparent on gross or histological examination., (© 2011 The Authors. Australian Veterinary Journal © 2011 Australian Veterinary Association.)

Purpose: The present study reviewed the clinical outcomes of 453 elderly patients with sigmoid volvulus (SV)., Methods: The clinical records were reviewed retrospectively., Results: The mean patient age was 71.1 years of age, and 371 patients (81.9%) were male. Of the patients, 30.7% had recurrent volvulus, 34.6% had associated disease, and 16.5% suffered from shock. The correct diagnosis rate based on the clinical features was 66.4%. Radiography revealed SV findings in 64.9% of the patients. Computed tomography (CT) or magnetic resonance imaging (MRI) were diagnostic in all cases. Nonoperative detorsion was performed in 323 patients (71.3%) with 77.4% success, 1.2% mortality, 4.0% morbidity, and 4.4% early recurrence rates. Emergency surgery was required in 215 patients (47.5%) and resulted in 24.2% mortality, 41.4% morbidity, 0.9% early recurrence, and 8.1% late recurrence rates., Conclusions: Elderly SV patients generally present with high percentages of recurrent volvulus, serious comorbidity, late admission, and shock. The clinical features may be less diagnostic. Radiological studies, particularly CT or MRI, may assist in an SV diagnosis. Nonoperative detorsion is advocated as the primary treatment. In emergency surgery, nonresectional or nonanastomotic procedures are preferred. The overall patient prognosis is grave, and the disease tends to recur.

Background: Abnormalities of rotation and fixation of the intestines are of intense interest to the pediatric surgeon, as they are frequently associated with volvulus which has catastrophic consequences when diagnosis is delayed or not even considered. This study evaluates the outcomes of surgical management of intestinal malrotation (IM) in children., Materials and Methods: The medical records of all patients with symptomatic malrotation, who underwent surgery between January 2000 and September 2009, were reviewed. Patients' characteristics, management, complications, and survival were evaluated., Results: Nine patients (eight boys and a girl) underwent surgery for malrotation at a median age of 15 days. Eight presented with acute symptoms and one with chronic symptoms. All the patients had symptoms of intermittent or complete upper intestinal obstruction, and malrotation was documented by an upper gastrointestinal contrast study in two of them. Volvulus was found at the time of surgery in seven patients, five of whom were neonates. One patient also had associated mesentery cyst. Seven patients were treated by Ladd's operation. One patient with massive bowel gangrene due to volvulus had right hemicolectomy. There was one perioperative death from anastomostic leak. Median length of stay was 9 days. Postoperative bowel obstruction was seen in two patients (one died), resulting in an overall mortality of 22.2%., Conclusions: Bowel gangrene from volvulus contributes to mortality, and small bowel adhesive intestinal obstruction is a cause of morbidity and mortality following surgery for IM. Neonates with bilious vomiting should raise the suspicion of malrotation until proven otherwise and given prompt intervention. There is a need for high index of suspicion in babies with bilious vomiting especially when recurrent to prevent devastating complications when present.

Objective: To evaluate the safety of single stage resection and primary anastomosis (RPA) in cases of viable sigmoid volvulus, in terms of anastomotic healing and complications., Study Design: Observational study., Place and Duration of Study: Surgical Unit, Hayatabad Medical Complex (HMC), Postgraduate Medical Institute, Peshawar, from November 2006 to October 2008., Methodology: Study included all patients presented and admitted in Surgical Unit, HMC, with sigmoid volvulus during the above mentioned period. Resection and primary anastomosis was done without defunctioning stoma formation or on-table colonic lavage. Manual decompression was carried out pre-operatively. Patients excluded, had serious co-morbid conditions in whom colostomy was done instead of primary anastomosis. Patients were followed-up for one month after surgery., Results: A total of 30 patients were admitted during the study of 2 years duration, out of which there were 21 male and 09 female patients, with male to female ratio of 2.4:1. Only 1 patient had anastomotic leak while 4 patients had superficial wound infection. One patient died due to comorbid condition. Abdominal wound dehiscence or postoperative abdominal abscess was not observed in any case., Conclusion: Single stage resection and primary anastomosis is a reliable current treatment modality for the emergency surgical management of sigmoid volvulus and has low morbidity and mortality. On-table colonic lavage and proximal defunctioning colostomies are unnecessary with this technique.

Purpose: The purpose of this study was to describe the population of pediatric patients waiting for intestinal transplant and to evaluate the risk of death or transplant by specific disease states., Methods: We studied the United Network for Organ Sharing (UNOS) database (Jan 1,1991 to 5/16/08) for patients 21 years old or younger at first listing for intestinal transplant and examined their age, sex, weight, and diagnoses. Time to list removal was summarized with cumulative incidence curves. Multinomial logistic regression was used to compare relative risk ratios for removal from the list for transplant, death, or other reasons., Results: We identified 1712 children listed for intestinal transplant (57% male, 51% <1 year, weight 8.1 kg [IQR, 6.1-14.1] at listing). Median age and weight at transplant (n = 852) were 1 year (IQR, 1-5) and 10 kg (IQR, 6.5-16.3). Regression analysis demonstrated significant differences in outcomes among disease conditions (P < .001). Compared to the gastroschisis group, the relative risk ratio for death versus transplant was higher in the necrotizing enterocolitis group (P = .015), lower in the short gut syndrome group (P = .001), and not different in the volvulus group (P = .94) after adjustment for weight and sex., Conclusions: We conclude that the relative risk of transplant vs death varies significantly by the disease condition of the patient., (Copyright 2010 Elsevier Inc. All rights reserved.)

Introduction: Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction., Patients and Methods: We reviewed our unit's experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions., Results: Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group., Conclusions: Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.

Objective: To report complications and survival after large colon resection and end-to-end anastomosis in horses with strangulating large colon volvulus., Study Design: Retrospective case series., Animals: Horses (n=73) with strangulating large colon volvulus., Methods: Records (January 1995 to December 2005) of horses that had large colon resection and anastomosis for strangulating large colon volvulus were reviewed for complications. Follow-up data were obtained by telephone questionnaire at least 1 year postoperatively. Cox proportional hazards model was used for multivariate association with survival time. Variables included admission date, age, temperature, heart rate, packed cell volume, total plasma protein concentration, white blood cell count, breed, and sex. Significance was set at P<.05., Results: The most common postoperative complication was diarrhea. None of the 9 variables of interest were significant for survival. Short-term survival rate (to discharge) was 74%. Overall survival rates at 1, 2, and 3 years postoperatively were 67.8%, 66.0%, and 63.5%, respectively. Four horses died of colic in the first year after surgery. All horses surviving long-term (>1 year) returned to their intended use (37 brood mares, 2 racehorses, and 1 show horse) with no chronic problems related to the surgical procedure., Conclusion: None of the variables examined were associated with survival. Outcomes were similar to other large studies of surgical colic in the horse. Self-limiting diarrhea is common after large colon resection and the prognosis for survival after hospital discharge is favorable., Clinical Relevance: Horses that survive the early postoperative period and are discharged after large colon resection and anastomosis have a good chance for long-term survival with minimal negative impact on quality of life and use.

Objective: To study the local patient profile, diagnostic methods, and treatment outcome in patients with large bowel volvulus to recommend a management plan., Methods: A retrospective study of patients record with a final diagnosis of large bowel volvulus treated at King Saud Medical Complex, Riyadh, Saudi Arabia between January 2000 and December 2007 were performed for patient demography, clinical presentations, co-morbidity, diagnostic methods, anatomical types, management, and outcome., Results: Forty-two patients with large bowel volvulus were reviewed. They represented 8.5% of all intestinal obstructions treated. Most had sigmoid volvulus (83%), were less than 60 years of age, and were male. Recognized risk factors were present in 12 (29%) patients. Diagnosis was suspected on plain abdominal x-ray in 28 patients (69%), although the characteristic signs of omega and coffee bean were seen in only 16 patients. Eight patients required emergency surgery. Endoscopic decompression was successful in 34 patients, followed by a definitive surgery in 24 patients. Seven patients refused surgery; 3 of them were readmitted with recurrence and were operated. Three patients were unfit for surgery. There were 3 deaths., Conclusion: Large bowel volvulus is uncommon in this area. Abdominal distension with pain, constipation, and characteristic gas pattern in plain x-ray can help diagnose most cases. Decompression can be achieved in most patients with sigmoid volvulus, followed by surgery during the same hospital admission. Transverse colon and cecal volvulus usually need emergency surgery.

Aim: To evaluate the efficacy of resection and primary anastomosis (RPA) and RPA with modified blow-hole colostomy for sigmoid volvulus., Methods: From March 2000 to September 2007, 77 patients with acute sigmoid volvulus were treated. A total of 47 patients underwent RPA or RPA with modified blow-hole colostomy. Twenty-five patients received RPA (Group A), and the remaining 22 patients had RPA with modified blow-hole colostomy (Group B). The clinical course and postoperative complications of the two groups were compared., Results: The mean hospital stay, wound infection and mortality did not differ significantly between the groups. Superficial wound infection rate was higher in group A (32% vs 9.1%). Anastomotic leakage was observed only in group A, with a rate of 6.3%. The difference was numerically impressive but was statistically not significant., Conclusion: RPA with modified blow-hole colostomy provides satisfactory results. It is easy to perform and may become a method of choice in patients with sigmoid volvulus. Further studies are required to further establish its role in the treatment of sigmoid volvulus.

Objectives: To determine the outcome of emergency resection of sigmoid volvulus and to determine the factors associated with adverse outcome., Design: Retrospective case series review., Setting: Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya., Subjects: All cases of sigmoid volvulus operated at MTRH during the six years period between year 2000-2005., Main Outcome Measures: Mortality rate; morbidity rate; and duration of hospital stay., Results: Ninety two case files were analysed. Sigmoid volvulus accounted for 14.1% of all cases of intestinal obstruction and 80% of large gut obstruction. The mean age was 47.3 years and the median was 50 years. The range was 16 to 86 years. The male to female ratio was 29.3:1. Mortality was three (3.3%) cases and the morbidity was 20 (21.7%) cases. The mean duration of hospital stay was 11.8 days. Inadequate intravenous fluid therapy had a statistically significant adverse effect on outcome in this study. The yearly outcome remained unchanged during the six years of the study., Conclusions: Emergency resection in cases with a viable colon had a similar outcome to the traditional standard treatment by emergency endoscopic derotation followed by semi-elective or elective resection. The overall outcome was comparable to global standards. Inadequate postoperative intravenous fluid therapy significantly affected the outcome.

Objectives: To determine the relationship between plasma lactate concentration and colonic viability and survival in horses with >or=360 degrees volvulus of the ascending colon., Study Design: Retrospective study., Animals: Horses (n=73) with >or=360 degrees volvulus of the ascending colon., Methods: Medical records (January 2000-November 2005) of all horses examined for colic at Michigan State University Veterinary Teaching Hospital were reviewed. Horses were included only if plasma lactate concentration was measured preoperatively and a diagnosis of >or=360 degrees volvulus of the ascending colon was confirmed by surgery or necropsy. Non-survivors were only included if the ascending colon was evaluated histopathologically. Logistic regression analysis was used to model the relationship between lactate, colonic viability, and survival., Results: Of 73 horses, 61 were discharged. Mean (+/-SD) plasma lactate concentration was significantly lower in survivors (2.98+/-2.53 mmol/L) compared with non-survivors (9.48+/-5.22 mmol/L; odds ratio [OR]=1.628, 95% confidence limit [CI]=1.259-2.105). Plasma lactate concentration was significantly lower in horses with a viable colon (3.30+/-2.85 mmol/L) compared with horses with a non-viable colon (9.1+/-6.09 mmol/L; OR=1.472, 95% CI=1.173-1.846). Plasma lactate concentration <6.0 mmol/L had a sensitivity of 84% and a specificity 83% for predicting horse survival., Conclusions: Our results demonstrate a strong association between plasma lactate concentration at the time of hospital admission and outcome in horses with >or=360 degrees volvulus of the ascending colon., Clinical Relevance: Plasma lactate concentration may help predict colonic viability and horse survival after ascending colon volvulus in horses.

Purpose: This study was designed to review the outcomes of emergent treatment of sigmoid colon volvulus., Methods: The records of 827 patients were reviewed retrospectively., Results: The mean age was 57.9 years (range, 10 weeks to 98 years), and 688 patients (83.2 percent) were male. Nonoperative reduction was applied in 575 patients (barium enema in 13, rigid sigmoidoscopy in 351, and flexible sigmoidoscopy in 211, with rectal tube placement in all patients). The results were as follows: success of 78.1 percent, mortality of 0.9 percent, complication of 3 percent, and early recurrence of 3.3 percent. Surgical treatment was performed on 393 patients (detorsion in 46, mesosigmoidopexy in 56, exteriorization in 4, resection with Hartmann's procedure in 146, resection with Mikulicz procedure in 14, resection with primary anastomosis in 51, tube cecostomy and colonic cleansing with resection in 75, and laparotomy in 1). The results were as follows: mortality of 15.8 percent, complication of 37.2 percent, early recurrence of 0.8 percent, and late recurrence of 6.7 percent., Conclusions: Nonoperative reduction is the initial treatment of sigmoid colon volvulus, and flexible sigmoidoscopy with rectal tube placement can be used successfully. Patients in whom bowel gangrene or peritonitis is present or nonoperative treatment is unsuccessful need emergency surgery. In surgical treatment, resection and primary anastomosis is the first choice, and it can be performed with acceptable mortality and morbidity rates if the patient is stable and a tension-free anastomosis is possible. Nondefinitive procedures have high recurrence rates; thus, definitive surgical techniques must be preferred.

There is a suspicion that mortality in gangrenous sigmoid volvulus has considerably declined over the recent years. This study was aimed to assess if this is a genuine trend, applicable to the patients, of this study too, and to identify factors responsible for the change, if any. Seventy-eight patients operated for gangrenous sigmoid volvulus, in the last four decades of the just gone century, were analysed. Nine clinical parameters were studied to identify factors responsible for mortality and to see if there was a change in clinical presentation in the later decades. Mortality in the 4 studied decades varied between 15.4% and 65%. Differences were significant (p<0.05) only between the decades of the seventies and eighties and between bunched pre 1980 (48%) and post 1980 (20%) decades. A sea change in survival scene occurred at the end of the decade of the seventies. The change was not accompanied by a concomitant improvement in clinical presentation (p>0.05). Two facts which could explain improved survivals in the post. 1980 period were, the increased recognition of gangrene extending beyond the area of constriction and improved survival after primary anastomoses (p<0.05). These indicated a more accurate assessment of viability and the distance between the cut bowel ends, a stricter selection of cases for primary anastomosis and using Hartmann operation in doubtful situations. Mortality in gangrenous sigmoid volvulus, without knotting in the Indian population has genuinely declined from over 50% in an earlier time to 20% in the later 20 years of the last century, the watershed in the changed scenario being the year 1980.

The records of 19 patients with sigmoid colon volvulus (SCV) who were treated surgically in a 36.5-year-period were reviewed. Seven of them (37 %) had ileosigmoidal knotting (ISK). The age range was between 10 weeks and 17 years (mean 10 years), and 17 patients (90%) were male. In two cases (11%) there was previous SCV history. The mean symptom duration was 57 h (range 24-96), and three patients (16%) were in shock. The main symptoms were abdominal pain (90%), distention (79%), vomiting (74%), and obstipation (58%), and the main signs were abdominal tenderness (90%), distention (79%), absence of stool in the rectum and hypo- or akinetic bowel sounds (58%), muscular rigidity (53%), hyperkinetic bowel sounds (32%), and melanotic stool in the rectum (21%). The torsion was found in a clockwise direction in 47%, and the torsion degree was 360 in 42%. In four patients (21%) there was no gangrene (one with ISK), whereas in 15 (79%) sigmoid colon was gangrenous (six with ISK, in whom small bowel was also gangrenous). In nongangrenous cases, detorsion (11%) or sigmoidopexy (11%) was performed. In gangrenous cases, gangrenous sigmoid colon was resected, and Hartmann's procedure (74%) or primary anastomosis (5%) was performed. In those with associated gangrene of the small bowel, resection and enteroenteric anastomosis were done. Four patients (21%) died, with the most common cause of death being toxic shock. In 11 patients, including five with SCV and six with ISK, no recurrence was seen in a mean 18-year follow-up period (range 8-39). As a result, preoperative resuscitation, prompt surgery, and postoperative support are important in emergent SCV in children.

Background and Aims: Emergency resection and primary anastomosis of unprepared left-colon is a controversial subject. Although this approach has been reported in several series, there is paucity of data on the relative safety of it in viable vs. gangrenous colon especially when the gut is unprepared., Patients and Methods: Case records of 57 consecutive patients with acute sigmoid volvulus were reviewed; there were 27 with gangrenous colon (group G) and 30 with viable colon (group V). All of them had undergone emergency resection and primary anastomosis without on-table lavage or caecostomy., Results: Group G had a lower mean haemoglobin value (8.4 vs. 9.7 g/dl) and higher incidence of circulatory shock on admission (26% vs. 7%) and required more blood transfusion (85% vs. 53%) than group V. Mean hospital stay (16 vs. 12 days), overall anastomotic leak (15% vs. 27%) and mortality (3.5% vs. 3%) did not differ significantly between the groups. However, the rate of wound infection in Group G was four times greater than that of group V., Conclusion: One-stage restorative resection without on-table lavage or caecostomy appears to be a promising alternative in the emergency management of acute sigmoid volvulus. Comparison of primary anastomosis in gangrenous vs. viable colon did not reveal any significant difference in hospital stay, rate of anastomotic leak or mortality. However, the risk of wound infection was more in patients with gangrenous sigmoid volvulus.