ABSTRACT
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.
Subject(s)
Conservative Treatment , Digestive System Surgical Procedures , Intestinal Volvulus/therapy , Sigmoid Diseases/therapy , Adult , Aged , Aged, 80 and over , Barium Enema , Colonoscopy , Conservative Treatment/adverse effects , Conservative Treatment/mortality , Digestive System Surgical Procedures/adverse effects , Digestive System Surgical Procedures/mortality , Female , Hospitals, University , Humans , Iceland/epidemiology , Intestinal Volvulus/diagnosis , Intestinal Volvulus/mortality , Length of Stay , Male , Middle Aged , Progression-Free Survival , Recurrence , Retrospective Studies , Risk Factors , Sigmoid Diseases/diagnosis , Sigmoid Diseases/mortality , Time FactorsABSTRACT
INTRODUCTION: Intussusception occurs when a proximal portion of the bowel invaginates into the distal bowel. It is the most common cause of intestinal obstruction in children between 3 months and 3 years. This study aimed to assess patient profile, clinical presentation, diagnostic methods, treatment and outcome in children diagnosed with intussusception in Iceland. MATERIAL AND METHODS: We conducted a retrospective chart review of all children diagnosed with intussusception in Iceland during a 25 year period (1986-2010). Patients were identified from a medical record database in Iceland's two main hospitals, Landspítali and Akureyri Hospital. RESULTS: A total of 67 children aged 3 months to 11 years (median age 8 months) were diagnosed with intussusception. Male to female ratio was 3:2. The mean incidence of intussusception was 0.4 cases per 1000 children <1 year old. Intussusception was idiopathic in 70% of patients and occurred in the ileocolic region in 94%. Barium contrast enema was the most common diagnostic test. Barium enema reduction was attempted in 82% of patients and successful reduction rate was 62%. Surgical treatment was required in 49% of patients and involved resection of bowel in 9%. Three children had recurrent intussusception. CONCLUSION: The results of treatment for intussusception in Iceland are good. The decline of enemas performed and the rise in surgical treatment observed over the study period is a reason for concern. In this regard there is room for improvement.
