The changing survival scenario in gangrenous sigmoid volvulus: a four-decade study.

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.

Volvulo de sigmoides: estudio de los pacientes operados en el Hospital Nacional Cayetano Heredia 1969-1989 / Sigmoid volvulus: study of the patients with operative treatment in Hospital Nacional Cayetano Heredia 1969-1989

Se realizó una evaluación retrospectiva de 57 pacientes operados por vúlvulo de sigmoides en el HNCH. Edad promedio de 51 años. Predominó el sexo masculino. La gestación se presentó en 4 casos. Tiempo de enfermedad promedio 3.9 dias. Las manifestaciones clínicas más frecuentes fueron: dolor y distensión abdominal (100 por ciento), no eliminación de heces y flatos (94.7 por ciento), ruidos hidroaéreos disminuidos o ausentes (78.9 por ciento), vómitos (56.1 por ciento). El estudio radiológico fue característico de esta patología. Los principales hallazgos operatorios fueron: sigmoides isquémicos y peritonitis. Las técnicas quirúrgicas realizadas: desvolvulación (36.8 por ciento) y resección primaria con anastomosis termino-terminal (28.1 por ciento) o con colostomía a lo Hartmann (28.1 por ciento). Las complicaciones post-operatorias más frecuentes: compromiso respiratorio (33.3 por ciento) e infección de herida operatoria (25 por ciento) La causa más frecuentes de reintervención quirúrgica fue evisceración. Permanencia hospitalaria promedio de 17.5 dias. La recurrencia y mortalidad fue de 7 por ciento respectivamente