Abstract：
OBJECTIVE: Sigmoid volvulus (SV) is a common cause of bowel obstruction, especially in older patients. SV can be mesenteroaxial (M-SV) or organoaxial (O-SV). The purpose of this study was to assess if CT findings in SV are associated with clinical outcomes. including recurrence, choice of management, and mortality.
METHODS: This study includes patients with SV and a CT within 24 hours of presentation. CT features, including mesenteraoxial/organoaxial arrangement, direction of rotation, transition points, distension, whirl-sign, ischemia, and perforation were determined. Demographics, treatment, recurrence, and outcome data were recorded.
RESULTS: One hundred and seventeen cases were diagnosed in 80 patients (54 male). The mean age was 70 years (± 17.1). M-SV and O-SV were equally prevalent (n = 39 vs. n = 41, respectively). M-SV was significantly more common with anticlockwise rotation in the axial plane (p = 0.028) and clockwise rotation in the coronal plane (p = 0.015). All patients with imaging features of ischemia underwent surgery (n = 6). There was no significant difference in outcome variables (30-day mortality, 30-day readmission, recurrence) between the O-SV and M-SV groups. The degree of bowel distension on initial presentation was a significant predictor of recurrence, with ≥ 9 cm vs < 9 cm associated with an increased odds of any recurrence (OR: 3.23; 95%CI: 1.39-7.92).
CONCLUSIONS: In SV, sigmoid distension of more than 9 cm at baseline CT was associated with an increased risk of recurrence. Imaging features of ischemia predicted surgical over endoscopic intervention. Organoaxial and mesenteroaxial SV had similar prevalence, but the type of volvulus was not associated with clinical outcomes or choice of management.
CONCLUSIONS: There is a risk of recurrent sigmoid volvulus with colonic distension greater than 9 cm. This work, comparing volvulus subtypes, shows that this finding at the initial presentation could expedite consideration for surgical management.
CONCLUSIONS: Reports of outcomes for different subtypes and rotational directions of volvuli have been contradictory. No difference in measured outcomes was found between subtypes; distension ≥ 9 cm predicted recurrence. CT features can aide management of sigmoid volvulus and can prompt surgical intervention.
METHODS: This study includes patients with SV and a CT within 24 hours of presentation. CT features, including mesenteraoxial/organoaxial arrangement, direction of rotation, transition points, distension, whirl-sign, ischemia, and perforation were determined. Demographics, treatment, recurrence, and outcome data were recorded.
RESULTS: One hundred and seventeen cases were diagnosed in 80 patients (54 male). The mean age was 70 years (± 17.1). M-SV and O-SV were equally prevalent (n = 39 vs. n = 41, respectively). M-SV was significantly more common with anticlockwise rotation in the axial plane (p = 0.028) and clockwise rotation in the coronal plane (p = 0.015). All patients with imaging features of ischemia underwent surgery (n = 6). There was no significant difference in outcome variables (30-day mortality, 30-day readmission, recurrence) between the O-SV and M-SV groups. The degree of bowel distension on initial presentation was a significant predictor of recurrence, with ≥ 9 cm vs < 9 cm associated with an increased odds of any recurrence (OR: 3.23; 95%CI: 1.39-7.92).
CONCLUSIONS: In SV, sigmoid distension of more than 9 cm at baseline CT was associated with an increased risk of recurrence. Imaging features of ischemia predicted surgical over endoscopic intervention. Organoaxial and mesenteroaxial SV had similar prevalence, but the type of volvulus was not associated with clinical outcomes or choice of management.
CONCLUSIONS: There is a risk of recurrent sigmoid volvulus with colonic distension greater than 9 cm. This work, comparing volvulus subtypes, shows that this finding at the initial presentation could expedite consideration for surgical management.
CONCLUSIONS: Reports of outcomes for different subtypes and rotational directions of volvuli have been contradictory. No difference in measured outcomes was found between subtypes; distension ≥ 9 cm predicted recurrence. CT features can aide management of sigmoid volvulus and can prompt surgical intervention.
摘要：
目的：乙状结肠扭转（SV）是肠梗阻的常见原因，尤其是老年患者。SV可以是肠系膜轴(M-SV)或有机轴(O-SV)。这项研究的目的是评估SV的CT表现是否与临床结果相关。包括复发,管理的选择，和死亡率。
方法：本研究包括在24小时内出现SV和CT的患者。CT特征,包括肠系膜/有机轴向排列，旋转方向,过渡点,扩张，旋转标志，缺血,并确定了穿孔。人口统计,治疗,复发,并记录结果数据.
结果：80例患者（男性54例）中诊断出117例。平均年龄为70岁（±17.1）。M-SV和O-SV同样普遍(n=39vs.分别为n=41)。M-SV在轴向平面中逆时针旋转（p=0.028）和在冠状平面中顺时针旋转（p=0.015）明显更常见。所有具有缺血影像学特征的患者均接受手术治疗(n=6)。结果变量没有显着差异（30天死亡率，重新接纳30天,复发）在O-SV和M-SV组之间。最初表现时的肠扩张程度是复发的重要预测因素，≥9cm和<9cm与任何复发的几率增加相关(OR:3.23;95CI:1.39-7.92)。
结论：在SV中，基线CT时乙状结肠扩张超过9cm与复发风险增加相关.缺血的影像学特征预测手术优于内镜干预。器官轴和肠系膜轴SV的患病率相似，但肠扭转类型与临床结局或治疗选择无关.
结论：乙状结肠扩张大于9厘米，有反复发作的风险。这项工作,比较肠扭转亚型，表明，这一发现在最初的介绍可以加快考虑手术管理。
结论：关于不同亚型和扭转方向的结果报告相互矛盾。亚型之间的测量结果没有差异；扩张≥9cm预测复发。CT特征可以帮助乙状结肠扭转的治疗，并可以提示手术干预。
方法：本研究包括在24小时内出现SV和CT的患者。CT特征,包括肠系膜/有机轴向排列，旋转方向,过渡点,扩张，旋转标志，缺血,并确定了穿孔。人口统计,治疗,复发,并记录结果数据.
结果：80例患者（男性54例）中诊断出117例。平均年龄为70岁（±17.1）。M-SV和O-SV同样普遍(n=39vs.分别为n=41)。M-SV在轴向平面中逆时针旋转（p=0.028）和在冠状平面中顺时针旋转（p=0.015）明显更常见。所有具有缺血影像学特征的患者均接受手术治疗(n=6)。结果变量没有显着差异（30天死亡率，重新接纳30天,复发）在O-SV和M-SV组之间。最初表现时的肠扩张程度是复发的重要预测因素，≥9cm和<9cm与任何复发的几率增加相关(OR:3.23;95CI:1.39-7.92)。
结论：在SV中，基线CT时乙状结肠扩张超过9cm与复发风险增加相关.缺血的影像学特征预测手术优于内镜干预。器官轴和肠系膜轴SV的患病率相似，但肠扭转类型与临床结局或治疗选择无关.
结论：乙状结肠扩张大于9厘米，有反复发作的风险。这项工作,比较肠扭转亚型，表明，这一发现在最初的介绍可以加快考虑手术管理。
结论：关于不同亚型和扭转方向的结果报告相互矛盾。亚型之间的测量结果没有差异；扩张≥9cm预测复发。CT特征可以帮助乙状结肠扭转的治疗，并可以提示手术干预。
