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Optimal interval from decompression to semi-elective operation in sigmoid volvulus.

BACKGROUND/AIMS
The initial non-operative decompression and subsequent semi-elective operation is a common strategy in managing sigmoid volvulus. However, the optimal interval between decompression and operation is still unclear.


METHODOLOGY
From 1994 to 2004, 25 patients operated on for sigmoid volvulus at the National Taiwan University Hospital were enrolled. The treatment strategy and clinical outcome in these patients were retrospectively reviewed and analyzed.


RESULTS
Twenty-one patients underwent successful non-operative decompression initially, and the remaining 4 patients underwent emergent operation. Gangrene of the colon was found in 3 patients, and all of them eventually died of medical complications, i.e. multiple organ failure, pneumonia and myocardial infarction. One leakage but no mortality occurred in the patients undergoing semi-elective operation. The rate of postoperative complication was not significantly different between the patients operated on 2 days and more than 2 days after the decompression.


CONCLUSIONS
The initial non-operative decompression and subsequent semi-elective operation results in a satisfactory outcome in managing sigmoid volvulus. In the view of surgical result, a two-day interval seems adequate for bowel preparation and optimization of the patient's condition.