Minimizing recurrence after sigmoid volvulus

Background: This study was a retrospective review of a series of patients w ith sigmoid volvulus to identify risk factors for recurrence and recommend appropriate treatment. Methods: Thirty-five patients with sigmoid volvulus were treated over 8 yea rs. Results: Six patients had emergency surgery for peritonitis. Twenty-eight o f the other 29 patients had successful endoscopic decompression; 15 of thes e patients had elective surgery during the same admission. Twelve of the 14 patients who refused operation after endoscopic decompression developed re current volvulus, a median of 2.8 months later. Eight subsequently agreed t o surgery and underwent elective operation following repeat decompression. Of 29 patients who had surgery, 27 had sigmoid colectomy (two were initial Hartmann procedures) and two had subtotal colectomy. Six patients who had s igmoid colectomy developed recurrent volvulus. Concomitant megacolon and me garectum at the time of initial surgery were significant predictors of recu rrence. Conclusion: Subtotal colectomy, carried out as the primary procedure if the re is concomitant megacolon or megarectum, might reduce the risk of recurre nt sigmoid volvulus.