Dataset Information

Prediction of the Clinical Outcomes of Sigmoid Volvulus by Abdominal X-Ray: AXIS Classification System.

ABSTRACT:

Aim

Early diagnosis and evaluation of the severity of sigmoid volvulus are necessary for management and early intervention. We developed a new predictive classification system for sigmoid volvulus based on X-ray findings.

Methods

We retrospectively analyzed 66 patients diagnosed with sigmoid volvulus using the electronic medical records at the Osaki Citizen's Hospital and the University of Tokyo Hospital from 2008-2015. We classified patients according to the coffee-bean sign mesenteric axis on X-ray (AXIS classification: group A, 0-90°; group B, 90-135°; and group C, >135°). We examined the association between AXIS classification and severe sigmoid volvulus, intestinal necrosis, need for surgery, 30-day mortality, and length of stay using the Cochran-Armitage trend test.

Results

In total, 66 patients were analyzed. They had a mean age of 76.9 years, and 47 (71.0%) were male. They were classified into three groups according to the AXIS classification system (group A, 40 patients; group B, 23 patients; and group C, 3 patients). Group C had a significantly higher frequency of severe sigmoid volvulus (100%) compared to group B (30%) and group A (15%). AXIS classification was significantly associated with the severity of sigmoid volvulus (p = 0.003), necrosis (p = 0.004), and need for surgery (p = 0.001), but not with the 30-day mortality or the length of stay.

Conclusions

We developed the AXIS classification system to predict the severity of sigmoid volvulus. This new classification system may facilitate triage and therapeutic decision-making for sigmoid volvulus patients.

SUBMITTER: Ishibashi R

PROVIDER: S-EPMC6276422 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Prediction of the Clinical Outcomes of Sigmoid Volvulus by Abdominal X-Ray: AXIS Classification System.

Ishibashi Rei R Niikura Ryota R Obana Nobuya N Fukuda Sho S Tsuboi Mayo M Aoki Tomonori T Yoshida Shuntaro S Yamada Atsuo A Hirata Yoshihiro Y Koike Kazuhiko K

Gastroenterology research and practice 20181115

<h4>Aim</h4>Early diagnosis and evaluation of the severity of sigmoid volvulus are necessary for management and early intervention. We developed a new predictive classification system for sigmoid volvulus based on X-ray findings.<h4>Methods</h4>We retrospectively analyzed 66 patients diagnosed with sigmoid volvulus using the electronic medical records at the Osaki Citizen's Hospital and the University of Tokyo Hospital from 2008-2015. We classified patients according to the coffee-bean sign mese ...[more]

PMID: 30581464

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Project description:BackgroundMost patients with sigmoid volvulus are of old age with multiple comorbidities. So, the risk of surgery for those elderly patients is usually associated with increased rates of morbidity and mortality. Early intervention is required for managing sigmoid volvulus to avoid its serious complications; therefore, early endoscopic untwist of sigmoid colon can be performed followed by endoscopic fixation of sigmoid colon under sedation in this category of the patients to avoid development of high risk surgical complications following surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy procedure to relieve obstruction.MethodsThis prospective randomized controlled clinical trial included all patients who developed acute sigmoid volvulus and were referred to the Zagazig University Hospital Emergency Department between December 2020 and August 2022. The study was prospectively approved by Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9989/23-10-2022) and was retrospectively submitted in http://clinicaltrials.gov in November 2022 ( http://clinicaltrials.gov ID: NCT05620446). Included eligible patients were simply randomized at a 1:1 ratio to "Endoscopic Group (EG)" or "Surgical Group (SG)" via drawing of sealed envelopes containing computer-generated random numbers prepared by a third party before start of intervention.ResultsSample size included 18 patients divided into 2 equal groups. (1) Endoscopic group included 9 patients who were subjected to endoscopic untwist of sigmoid colon followed by endoscopic fixation of sigmoid colon under sedation; (2) Surgical group included 9 patients who were subjected to surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy under general anesthesia. In comparison between both groups, there were statistically significant differences regarding length of hospital stay and procedure time. Unfortunately, there were no statistically significant differences regarding postoperative complications and co-morbidities. Eight patients in the endoscopy group demonstrated excellent quality of life, and one demonstrated good quality of life; unlike the surgical group, there were 3 patients with excellent quality of life, 5 patients with good quality of life, and 1 patient with poor quality of life. So there was statistically significant difference regarding quality of life between both groups. During the 9-month follow-up period, both groups demonstrated no cases of recurrence post-fixation.ConclusionEndoscopic management of acute sigmoid volvulus is effective and safe in elderly high risk surgical patients (either in managing the intestinal obstruction caused by volvulus or in definitive treatment of volvulus).

Dataset Information

Prediction of the Clinical Outcomes of Sigmoid Volvulus by Abdominal X-Ray: AXIS Classification System.

Aim

Methods

Results

Conclusions

Publications

Prediction of the Clinical Outcomes of Sigmoid Volvulus by Abdominal X-Ray: AXIS Classification System.

Similar Datasets

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