Læknablaðið - 01.09.2018, Blaðsíða 14

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5.
Heimildir
Barst til blaðsins 13. mars 2018, samþykkt til birtingar 29. júní 2018.
Hörður Már Kolbeinsson1
Birta Dögg Ingudóttir Andrésdóttir1
Pétur H. Hannesson2,23
Elsa Björk Valsdóttir1,3
Páll Helgi Möller1,3
Backround
Sigmoid volvulus is an uncommon cause of
bowel obstruction in most western societies.
Treatment options include colonoscopy in
uncomplicated disease with elective surgery
later on. The aim of this study was to assess
what treatment sigmoid volvulus patients receive
along with long-term outcomes at Landspitali
University Hospital.
Methods
The study was retrospective. Patients diagnos-
ed with sigmoid volvulus at Landspitali Uni-
versity Hospital from 2000-2013 were included.
Information regarding age, sex, and duration of
hospital stay, treatment, short and long-term
outcomes were gathered.
Results
Forty-nine patients were included in the study,
of which 29 men and 20 women. Mean age was
74 (25-93). One patient underwent acute sur-
gery on first arrival due to signs of peritonitis.
Others (n=48) were treated conservatively in the
first attempt with colonoscopy (n=45), barium
enema (n=2) and rectal tube (n=1). Three other
patients underwent acute surgery due to failed
colonoscopy, 8 patients had planned surgery
during the index admission. Thirty-six patients
were discharged after conservative treatment
with colonoscopy (n=35), barium enema (n=1) or
rectal tube (n=1). Two patients came in for elec-
tive surgery later on. Twenty-two patients (61%)
had recurrence. Median time to recurrence was
101 days (1-803). Disease-free probability in 3, 6
and 24 months was 66%, 55% and 22% respec-
tively. Total disease related mortality was 10.2%.
Mortality (30 days) after acute surgery was 25%
(1/4) and 16,6% (3/18) after planned surgery.
Conclusions
Sigmoid volvulus has high recurrence rate if not
treated operatively. Total mortality due to sig-
moid volvulus at Landspitali is low but surgery
related mortality high.
Sigmoid volvulus at the University Hospital of Iceland 2000-2013
ENGLISH SUMMARY
1Surgical unit, 2X-ray department, 3faculty of medicine, University of Iceland.
Key words: sigmoid volvulus, bowel obstruction, surgery, colonoscopy.
Correspondence: Hörður Már Kolbeinsson, hordurma@gmail.com
394 LÆKNAblaðið 2018/104
skurðaðgerðir milli rannsókna en því hefur verið lýst á bilinu 10-
100% þó að oftar en ekki sé tíðnin í kringum 10%.1,4,9,15 Hjá okkur
var 16,6% dánartíðni eftir skipulagðar aðgerðir, sem er hærra en
yfirleitt er lýst erlendis og teljum við það styrkja þá skýringu að
aldur og almennt ástand þessara sjúklinga spili hér stórt hlutverk.
Þetta dánarhlutfall virðist töluvert hærra en við aðgerðir á ristli
og endaþarmi í flestum öðrum sjúklingaþýðum, til dæmis vegna
krabbameins en í nýlegri íslenskri samantekt var 30 daga dánar-
tíðni eftir aðgerð undir 1%.17
Helsti annmarki þessarar rannsóknar er að hún er afturskyggn
og reiðir sig því á nákvæma skráningu upplýsinga í sjúkraskrár-
kerfi, sem getur verið ábótavant.
Með þessari samantekt var leitast við að varpa ljósi á afdrif
sjúklinga með garnaflækju á bugaristli á Landspítala. Ljóst er að
garnaflækja á bugaristli er hættulegur sjúkdómur sem hefur sterka
tilhneigingu til endurkomu. Sjúklingar eru oft á tíðum aldraðir og
þjást af sjúkdómum sem gera ákvarðanatöku um meðferð erfiða.
Endurkomutíðni hér er há eins og þekkt er. Heildardánartíðni á
Landspítala vegna garnaflækju á bugaristli er lág í erlendum sam-
anburði en virðist aukast við endurteknar innlagnir og er há eftir
skurðaðgerðir.
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