Ileosigmoid knotting in the elderly: Outcomes of 32 cases over 44.5 years
Abstract
Objective: Ileosigmoid knotting (ISK), in which the ileum wraps around the base of the sigmoid colon, is a rare cause of intestinal obstruction. This study aimed to compare the clinical outcomes of ISK in elderly and nonelderly patients.
Methodology: The clinical records of thirty two elderly patients, sixty years of age or older were reviewed retrospectively at the Department of General Surgery, Faculty of Medicine, Ataturk University from June 1966 to January 2011.
Results: The mean age of the elderly patients was 65.5 years, and 24 patients (75.0%) were male. Of the patients, 37.5% had recurrent volvulus, 31.3% had comorbid disease, 78.1% suffered from shock, and these rates were higher in the elderly group (P < 0.05, P < 0.01, and P < 0.01, respectively). Although the mean symptom duration was longer in the elderly group (51.3 hours vs. 43.5 hours, P < 0.01), the clinical and radiological findings and the preoperative correct diagnosis rates were similar in the elderly and nonelderly groups (P > 0.05, in all). In addition to the types and the degrees of the torsion, bowel gangrene rate was also similar in both groups (P > 0.05, in all). Mortality and morbidity rates (34.4% vs. 10.3%, P < 0.05, in both) were higher in the elderly group. Similarly, hospitalization period was longer in the elderly patients (17.1 days vs. 12.2 days, P < 0.01).
Conclusion: ISK is generally present with high percentages of recurrent volvulus, comorbidity, late admission, and shock in elderly patients. Although the clinical features and diagnostic modalities are similar, ISK has a graver prognosis in elderly patients.
Methodology: The clinical records of thirty two elderly patients, sixty years of age or older were reviewed retrospectively at the Department of General Surgery, Faculty of Medicine, Ataturk University from June 1966 to January 2011.
Results: The mean age of the elderly patients was 65.5 years, and 24 patients (75.0%) were male. Of the patients, 37.5% had recurrent volvulus, 31.3% had comorbid disease, 78.1% suffered from shock, and these rates were higher in the elderly group (P < 0.05, P < 0.01, and P < 0.01, respectively). Although the mean symptom duration was longer in the elderly group (51.3 hours vs. 43.5 hours, P < 0.01), the clinical and radiological findings and the preoperative correct diagnosis rates were similar in the elderly and nonelderly groups (P > 0.05, in all). In addition to the types and the degrees of the torsion, bowel gangrene rate was also similar in both groups (P > 0.05, in all). Mortality and morbidity rates (34.4% vs. 10.3%, P < 0.05, in both) were higher in the elderly group. Similarly, hospitalization period was longer in the elderly patients (17.1 days vs. 12.2 days, P < 0.01).
Conclusion: ISK is generally present with high percentages of recurrent volvulus, comorbidity, late admission, and shock in elderly patients. Although the clinical features and diagnostic modalities are similar, ISK has a graver prognosis in elderly patients.
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