Risk factors of sigmoid volvulus in patients with idiopathic megacolon

AIM: to identify risk factors of sigmoid volvulus in patients with idiopathic megacolon/megarectum.

PATIENTS AND METHODS: the retrospective study included 151 patients with idiopathic megacolon/megarectum (2002-2023). The diagnosis of megacolon/megarectum was confirmed with a barium enema. Hirschsprung’s disease was excluded after anorectal manometry and (if needed) rectal wall biopsy by Swenson.

RESULTS: forty-seven (31.1%) idiopathic megacolon/megarectum patients have had sigmoid volvulus in history or during current admission. In univariate analysis the significant correlation was revealed between sigmoid volvulus rate and age, rate of defecation without assistance, rate of integral parameter “defecation difficulties”, Wexner constipation scale rate (p < 0.05). There also was significant correlation between sigmoid volvulus rate and sigmoid length, sigmoid width, rectum width and rate of distal retention in gut transit test (p < 0.05). Due to multivariate analysis (multiple logistic regression) the best fit has the model, which sigmoid length, sigmoid width, and rectum width were included (Somers’ D — 0.867, KS statistic — 0.718, p < 0.0001). Sigmoid width (OR = 2.29; CI 1.38– 3.82) and rectum width (OR = 0.39; CI 0.22–0,72) were independent factors affected sigmoid volvulus rate. In the ROC analysis the area under the curve was 0.93 with a sensitivity of 82.4% and specificity of 89.2% in Youden’s point of 0.719. The nomogram for sigmoid colon volvulus risk prediction in idiopathic megacolon/megarectum patients was build up based this model.

CONCLUSION: idiopathic megacolon is associated with risk of sigmoid volvulus. The risk of sigmoid volvulus more than 90% estimated with the nomogram can be considered as a reason for elective surgery in idiopathic megacolon/ megarectum patients without sigmoid volvulus in anamnesis.

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