Bilsel BAÇ, Mustafa ALDEMİR, İbrahim TAÇYILDIZ, Celalettin KELEŞ

Predicting factors for mortality in sigmoid volvulus

Sigmoid kolon, volvulusun en sık görüldüğü yerdir ve sigmoid volvulus (SV), yüksek mortalite ve morbiditeye sebep olur. Bu çalışmanın amacı, SV vakalarında mortaliteyi önceden belirleyen faktörleri değerlendirmek idi. Ocak 1994 ve Aralık 2001 tarihleri arasında, Dicle Üniversitesi Hastanesinde, SV nedeniyle ameliyat edilen hastaların kayıtları geriye dönük incelendi. Epidemiyolojik, klinik ve laboratuar özellikleri, mortalite için olası risk faktörleri olarak değerlendirildi. SV ile ilişkili değişkenler, logistik regresyon modelleri kullanılarak belirlendi. Toplam 90 hastanın, 80 (%88.9)'i erkek, 10 (11.1%)'i kadın idi. Yaş ortalaması, sorunsuz hastalar için (Grup 1) 58.8±12.9 (19-85) ve ölen hastalar için (Grup 2) 63.6±16.1 (23-83) idi (p=0.000). Başvuru öncesi semptomların süresi, Grup 1'de 2.2±0.73 (1-4) gün ve Grup 2'de 5.6±1.7 (2-10) gün (p=0.000) idi. Grup 1'deki hastaların %73.8'i, grup 2'deki hastaların %100'ü acil olarak operasyona alınmışlardı (p=0.002). Tek yönlü analizlerde, diğer önemli risk faktörleri; sıvı-elektrolit düzensizliği, artmış abdominal basınç, kardiovasküler hastalık, solunum yolu hastalığı, lökositoz, hipotansiyon, nekroz varlığı ve major kontaminasyon varlığı idi (p=0.000). Bu değişkenler, mortalite için risk faktörlerini ortaya çıkarmak için, logistik regresyon modeline girildi. Çok değişkenli analizlerde, uzun başvuru öncesi semptomların süresi [Odds Ratio (OR) =17.17, 95% Confidence Interval (CI) =2.86-103.07, P=0.002], başvuruda kardiovasküler hastalığın varlığı (OR=0.19, CI=0.001-0.52, P=0.019) ve yaş (OR=0.87, CI=0.77-0.99, P=0.046) mortalite için önemli ön belirleyici faktör olarak bulundu. Artmış intraabdominal basınç, sıvı-elektrolit düzensizliği, solunum yolu hastalığı ve major kontaminasyon SV sonrası mortalitede istatistiksel olarak önemli faktörler değildi. Çalışmamızda, başvuru öncesi semptomların süresinin uzamış olması, başvuruda kardiovasküler hastalığın varlığı ve yaşın, mortaliteyi önceden tahmin etmede etkili faktörler olduğunu tespit ettik.

Anahtar Kelimeler:

Kalp damar hastalıkları, Yaş faktörü, Ölüm oranı, İntestinal volvulus

Sigmoid volvulusta mortalite için ön belirleyici faktörler

Sigmoid colon is the most frequent site for a volvulus and volvulus of the sigmoid colon (SV) is characterized by a high morbidity and mortality. The objective of this study was to evaluate predicting factors for mortality in the SV cases. Between January 1994 and December 2001, the records of patients operated on due to SV at Dicle University Hospital (DUH) were retrospectively reviewed. The epidemiological, clinical, and laboratory features were evaluated as probable risk factors for mortality. Variables associated with SV were determined using logistic regression models. Of 90 patients, 80 (88.9%) were male, and 10 (11.1%) were female. The mean age was 58.8±12.9 (19-85) and 63.6±16.1 (23-83) for the patients with uneventful outcome (Group 1) and for the patients with fatal outcome (Group 2), respectively (p=0.000). The period of symptoms before admission (PSBA) were 2.2±0.73 (1-4) days and 5.6±1.7 (2-10) days in Group 1 and Group 2 respectively (p=0.000). While the 73.8 % of patients in the Group 1 were operated on an emergency state, 100 % of patients in the Group 2 were operated on an emergency state (p=0.002). In the univariate analysis, other significant risk factors were significantly fluid-electrolyte imbalance, elevated abdominal pressure (EAP), cardiovascular disease, respiratory disease, leukocytosis, hypotension, presence of necrosis, and presence of major contamination (p=0.000). These variables were entered into the logistic regression model for revealing the risk factors for mortality. In multivariate analysis, long PSBA [Odds Ratio (OR) =17.17, 95% Confidence Interval (CI) =2.86-103.07, P=0.002], presence of cardiovascular disease at the admission (OR=0.19, CI=0.001-0.52, P=0.019) and age (OR=0.87, CI=0.77-0.99, P=0.046) were found significantly predictive for mortality. EAP, fluid-electrolyte imbalance, respiratory disease, and presence of major contamination were not statistically significant factors for mortality after sigmoid volvulus. In our study, we determined that conditions, such as a long PSBA, presence of cardiovascular disease and age were predicting factors for mortality.

Keywords:

Cardiovascular Diseases, Age Factors, Mortality, Intestinal Volvulus,

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1. Baker DM, Wardrop PJC, Burell H, Hardcastle JD. The management of acute sigmoid volvulus in Nottingham. J R Coll Surg Edinb 1994; 39: 304-6.
2. Sinha RS. A clinical appraisal of volvulus of the pelvic colon with special reference to aetiology and treatment. Br J Surg, 1969; 56:838-40.
3. Mishra SB, Sahoo KP: Primary resection and anastomosis for volvulus of sigmoid colon. J Indian Med Assoc, 1986; 84:265-8.
4. Wilson H, Dunavant WD: Volvulus of the sigmoid colon. Surg Clin North Am 1965; 45:1245-51.
5. Ballantyne GH Review of sigmoid volvulus. Clinical patterns and pathogenesis. Dis Colon Rectum 1982 ; 25:823-30.
6. Friedman JD, Odland MD, Bubrick MP: Experience with colonic volvulus. Dis Colon Rectum 1989 ; 32:409-16.
7. Mangiante EC, Croce MA, Fabian TC, Moore OF, Britt LG: Sigmoid volvulus. A four-decade experience. Am Surg 1989; 55:41- 4.
8. Ballantyne GH: Review of sigmoid volvulus: history and results of treatment. Dis Colon Rectum 1982 ; 25:494-501.
9. Gibney EJ: Volvulus of the sigmoid colon. Surg Gynecol Obstet, 1991; 173:243-55.
10. Janik JS, Humphrey R, Nagaraj HS: Sigmoid volvulus in a neonate with imperforate anus. J Pediatr Surg, 1983; 18:636- 8.
11. Venugopal KS, Wilcox DT, Bruce J: Hirschsprung's disease presenting as sigmoid volvulus in a newborn. Eur J Pediatr Surg, 1997; 7:172-3.
12. Avots-Avotins KV, Waugh DE: Colon volvulus and the geriatric patient. Surg Clin North Am, 1982; 62:249-60.
13. Rosenthal MJ, Marshall CE: Sigmoid volvulus in association with parkinsonism. Report of four cases. J Am Geriatr Soc, 1987; 35:683-4.
14. Bak MP, Boley SJ: Sigmoid volvulus in elderly patients. Am J Surg, 1986; 151:71-5.
15. Siroospour D, Berardi RS: Volvulus of the sigmoid colon: a ten-year study. Dis Colon Rectum, 1976, 19:535-41.
16. Arigbabu AO, Badejo OA, Akinola DO: Colonoscopy in the emergency treatment of colonic volvulus in Nigeria. Dis Colon Rectum 1985; 28:795-8.
17. Gibney EJ: Sigmoid volvulus in rural Ghana. Br J Surg 1989; 76:737.
18. Osime U: Volvulus of the sigmoid colon. J R Coll Surg Edinb 1980; 25:32-7.
19. Anderson JR, Lee D: The management of acute sigmoid volvulus. Br J Surg 1981; 68:117-20.
20. Ryan P: Sigmoid volvulus with and without megacolon. Dis Colon Rectum 1982; 25:673-9.
21. Khoury GA, Pickard R, Knight M: Volvulus of the sigmoid colon. Br J Surg 1977; 64:587-9.
22. Pahlman L, Enblad P, Rudberg C, Krog M: Volvulus of the colon. A review of 93 cases and current aspects of treatment. Acta Chir Scand 1989; 155:53-6.
23. Welch GH, Anderson JR: Acute volvulus of the sigmoid colon. World J Surg 1987; 11:258-62.
24. Arnold GJ, Nance FC: Volvulus of the sigmoid colon. Ann Surg 1973; 177:527-37.
25. Taha SE, Suleiman SI: Volvulus of the sigmoid colon in the Gezira. Br J Surg, 1980; 67:433-5.
26. Ballantyne GH: Sigmoid volvulus: high mortality in county hospital patients. Dis Colon Rectum 1981, 24:515-20.
27. Forward AD: Hypokalemia associated with sigmoid volvulus. Surg Gynecol Obstet, 1966; 123:35-42.
28. Madiba TE, Thomson SR: The management of sigmoid volvulus. J R Coll Surg Edinb, 2000; 45:74-80.
29. Theuer C, Cheadle WG. Volvulus of the colon. Am Surg, 1991; 57:145-50.
30. Sroujieh AS, Farah GR, Jabaiti SK, el- Muhtaseb HH, Qudah MS, Abu-Khalaf MM: Volvulus of the sigmoid colon in Jordan. Dis Colon Rectum, 1992; 35:64-8.
31. Udezue NO: Sigmoid volvulus in Kaduna, Nigeria. Dis Colon Rectum, 1990; 33:647-9.
32. Tiwary RN, Prasad S: Mesocoloplasty for sigmoid volvulus: a preliminary report. Br J Surg, 1976; 63:961-2.
33. Khanna AK, Misra MK, Kumar K: Extraperitonealization for sigmoid volvulus: a reappraisal. Aust N Z J Surg, 1995; 65:496-8.
34. Schagen van Leeuwen JH: Sigmoid volvulus in a West African population. Dis Colon Rectum, 1985; 28:712-6.
35. Diebel LN, Dulchavsky SA, Brown WJ: Splanchnic ischemia and bacteria] translocation in the abdominal compartment syndrome. J Trauma 1997, 43:852-5.
36. Richardson JD, Trinkle JK: Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J Surg Res 1976; 20:401-4.
37. Diaz-Plasencia J, Rebaza-Iparraguirre H. An index of the severity of intestinal gangrene due to colonic volvulus. Rev Gastroenterol Peru 1993; 3:96-104.