Sigmoid volvulus: identifying patients requiring emergency surgery with the dark torsion knot sign.
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.
['Heo|Subin|S|', 'Kim|Hye Jin|HJ|http://orcid.org/0000-0002-0263-1581', 'Oh|Bum Jin|BJ|', 'Kim|Soo Jin|SJ|', 'Kim|Bohyun|B|', 'Huh|Jimi|J|', 'Lee|Jei Hee|JH|', 'Kim|Jai Keun|JK|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D012809:Colon, Sigmoid D003113:Colonoscopy D013505:Digestive System Surgical Procedures D004630:Emergencies D005260:Female D006801:Humans D045822:Intestinal Volvulus D007511:Ischemia D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D012189:Retrospective Studies D055815:Young Adult
Sepsis Emergency treatment Intestinal volvulus Multidetector-row computed tomography Sigmoid colon