Stratification of sigmoid volvulus early recurrence risk using a combination of CT features

Abstract

Purpose: The purpose of this study was to identify computed tomography (CT) features associated with early recurrence of sigmoid volvulus (SV) after a first uncomplicated episode and to develop a score for early SV recurrence risk stratification.

Materials and methods: A total of 95 patients (59 men, 36 women; mean age, 72 ± 15 [SD] years; age range: 57-87 years) who underwent abdominal CT examination for a first uncomplicated SV episode from January 1^st 2006 to July 31^st 2020 in two French University Hospitals were retrospectively included. A SV recurrence occurring within six months was defined as early SV recurrence. CT findings associated with SV were searched for using univariable analysis. CT features associated with early recurrence were computed into a multivariable logistic regression model that was further used to build a score to stratify SV recurrence risk. Kaplan-Meier curves were built to evaluate recurrence-free survival.

Results: Early SV recurrence occurred in 53 patients (56%). At multivariable analysis, left lateral section volume < 150 cm³ and maximal colon distension > 10 cm were associated with early SV recurrence (Odds ratio [OR] = 4.62; 95% CI: 1.77-13.33; P = 0.002 and OR = 4.43 95% CI: 1.63-13.63; P = 0.005) respectively), and an early SV recurrence score with 1 point attributed to each of these two variables was built. Early SV recurrence was observed in 26%, 54% and 89% of patients with score of 0, 1 and 2, respectively (P < 0.001).

Conclusion: A simple CT score allows stratification of early SV recurrence after a first episode and helps to select patient who would not benefit from prophylactic colonic surgery because of a low SV recurrence risk.

Keywords: Colon; Computed tomography; Intestinal volvulus; Recurrence; Risk assessment.