Twists and turns: A sigmoid volvulus clinical re-audit

Introduction: Sigmoid volvulus (SV) is a common cause of large bowel obstruction in older adults, carrying high morbidity, mortality, and recurrence. Following a previous audit, a local SV management pathway based on international guidelines (Tian et al., 2023) was introduced in 2024 to standardise care. This re-audit evaluated pathway compliance and its clinical impact.

Methods: Data was extracted retrospectively from electronic inpatient records for all patients admitted with SV between October 2024 and May 2026. Patient status at time of audit was also noted. Measures included demographics, time to endoscopic decompression, flatus tube placement, operative management, recurrence, mortality, and length of stay (LOS). Outcomes were compared to the index audit (2015–2021).

Results: Twenty-nine patients experienced 51 SV episodes. The cohort was older than the previous audit (mean age 83.4 vs 75.9 years; 19 men, 10 women). Mean time from admission to endoscopic decompression fell from 21.4 to 9.77 hours, meeting the pathway's 12-hour target. Flatus tube documentation improved modestly (19.6% vs 15.8%). Definitive surgery was discussed more frequently (60.8% vs 49%), and emergency surgery increased from 19% to 34.4%, predominantly via Hartmann's procedure or sigmoid colectomy. Mean LOS remained stable (8 vs 7.7 days). Seven patients (24%) had died at time of audit, reflecting cohort frailty. Recurrence remained high; 211 previous endoscopic decompressions were recorded across the cohort, with individual patients requiring up to 17 previous decompressions.

Conclusion: The SV pathway significantly improved key care processes, notably halving time to decompression and increasing surgical discussions. However, recurrent SV remains a heavy burden. Earlier definitive surgery post-decompression may reduce recurrence in select older patients. Targeted clinician education is needed to optimize adherence, and future research should investigate patient experiences.

References

Tian, B.W.C.A. et al. (2023) 'WSES consensus guidelines on sigmoid volvulus management', World Journal of Emergency Surgery, 18(1)