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Sigmoid volvulus: identifying patients requiring emergency surgery with the dark torsion knot sign

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Abstract

Objectives

To determine which clinical or CT imaging factors can help accurately identify complicated sigmoid volvulus (SV), defined as irreversible bowel ischaemia or necrosis requiring emergent surgery in patients with SV.

Methods

We performed a retrospective study of 51 patients admitted consecutively to the emergency department for SV. All patients attempted endoscopic detorsion as the first treatment. Clinical and contrast-enhanced CT factors were analysed. A newly described dark torsion knot sign (sudden loss of mucosal enhancement in the volvulus torsion knot) was included as a CT factor. Patients were diagnosed with complicated versus simple SV based on either surgery or follow-up endoscopic findings. Univariate and multivariate analyses were used to identify predictors of complicated SV.

Results

Of 51 study patients, 9 patients (17.6%) had complicated SV. Univariate analysis revealed that three clinical factors (sepsis, elevated C-reactive protein, and elevated lactic acid levels) and four CT factors (reduced bowel wall enhancement, increased bowel wall thickness, dark torsion knot sign, and diffuse omental infiltration) were significantly associated with complicated SV. Multivariate analysis identified only dark torsion knot sign (odds ratio = 104.40; p = 0.002) and sepsis (odds ratio = 16.85; p = 0.043) as independent predictive factors of complicated SV.

Conclusion

A newly defined CT imaging factor of dark torsion knot sign and a clinical factor of sepsis can predict complicated SV necessitating emergent surgery instead of colonoscopic detorsion as a primary treatment of choice.

Key Points

A newly defined CT imaging factor of dark torsion knot sign and a clinical factor of sepsis can be helpful for predicting complicated SV necessitating emergent surgery instead of endoscopic detorsion.

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Abbreviations

CRP:

C-reactive protein

NPV:

Negative predictive value

OR:

Odds ratio

PPV:

Positive predictive value

SV:

sigmoid volvulus

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Correspondence to Hye Jin Kim.

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The scientific guarantor of this publication is Hye Jin Kim.

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The authors declare that they have no competing interests.

Statistics and biometry

Soo Jin Kim kindly provided statistical advice and analysis for this manuscript.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at two institutions

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Heo, S., Kim, H.J., Oh, B.J. et al. Sigmoid volvulus: identifying patients requiring emergency surgery with the dark torsion knot sign. Eur Radiol 29, 5723–5730 (2019). https://doi.org/10.1007/s00330-019-06194-9

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  • DOI: https://doi.org/10.1007/s00330-019-06194-9

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