Survival outcomes in patients with sigmoid volvulus.

Aim: This study aimed to assess management pathways and outcomes in sigmoid volvulus (SV).

Methods: A retrospective review was performed on patients first admitted with SV between 2019 and 2023 within a tertiary-level colorectal service. Demographic, management, and outcome data, including frailty, ASA (American Society of Anaesthesiologists), and National Emergency Laparotomy Audit (NELA) score, were collected. Comparative statistics were used to compare baseline demographics between those operated on and those not and to identify factors associated with survival.

Results: A total of 72 patients were included, median age of 78 years, with 25 undergoing surgery. After index discharge without surgery, 50 patients (88%) were re-admitted with SV at least once, with a total of 212 hospital admissions and 1952 hospital bed days at the end of follow-up. A trend towards lower age, NELA score, ASA score and frailty score was seen in those undergoing surgery, with only two deaths observed during postoperative follow-up. In those who were not palliated at first admission but did not undergo surgery at any point, the mortality rate was 42% (n = 16, median survival 545 days, median age 79), with causes of death generally reflecting conditions of frailty and not volvulus itself.

Conclusions: This study demonstrates the burden of sigmoid volvulus in an elderly population with significant mortality and morbidity. While survival was better in those undergoing surgery, this likely represents appropriate case selection reflecting underlying frailty and comorbidities in those not offered surgery rather than a protective effect of surgery. While surgery should be considered and documented at index admission, it should not be considered a panacea for the elderly and frail population. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: This study highlights the burden of sigmoid volvulus in an ageing population, emphasising complex management challenges. Non-operative treatments showed high recurrence and poor survival, while surgery yielded excellent outcomes in selected patients. The findings advocate for a cautious, individualised approach, balancing frailty and risks, rather than universal reliance on surgery.