Title : Survival outcomes in patients with sigmoid volvulus
Abstract:
Introduction: This study aimed to assess management pathways and outcomes in sigmoid volvulus (SV) in an elderly population with significant morbidity and mortality.
Methods: A retrospective review was performed on patients first admitted with SV between 2019-2023 within a tertiary-level colorectal service. Demographic, management and outcome data were collected including frailty, ASA (American Society of Anaesthesiologists) and National Emergency Laparotomy Audit (NELA) score. Comparative statistics were used to compare baseline demographics between those operated on and those not and to identify factors associated with survival.
Results: A total of 72 patients were included, median age of 78, with 25 undergoing surgery. After index discharge without surgery, 50 patients (88%) were re-admitted with SV at least once, with a total of 212 hospital admissions and 1952 hospital bed days at the end of follow-up. A trend towards lower age, NELA score, ASA score and frailty score was seen in those undergoing surgery, with only 2 deaths observed during post-operative follow-up. In those who were not palliated at first admission but did not undergo surgery at any point, the mortality rate was 42% (n=16, median survival 545 days, median age 79), with causes of death generally reflecting conditions of frailty and not volvulus itself.
Conclusions: This study highlights the substantial burden of sigmoid volvulus in an elderly, frail population, with high recurrence following conservative management. While surgery significantly reduces recurrence, patient selection is critical due to age-related frailty and limited survival benefit. Comprehensive geriatric assessment should guide timely surgical decision-making, ideally following the index episode. Despite good postoperative outcomes, surgical decisions must balance recurrence risk with functional independence and quality of life. Enhanced documentation, multidisciplinary input, and consideration of less invasive alternatives such as percutaneous endoscopic colostomy are essential. Future multicentre studies should prioritise functional and frailty-related outcomes to optimise care pathways.
