From the Guidelines
Sigmoid volvulus should be diagnosed and treated with urgent endoscopic decompression, followed by sigmoid colectomy to prevent recurrence, as recommended by the most recent guidelines 1. The diagnosis of sigmoid volvulus involves a focused history and physical examination, as well as diagnostic imaging with plain abdominal radiographs and CT scans if necessary 1.
- The clinical presentation of sigmoid volvulus typically includes abdominal pain, constipation, and vomiting, with a classic triad of symptoms present in 30-41% of cases 1.
- The diagnosis can be confirmed with plain abdominal radiographs showing a coffee bean sign, and CT scans can be used to evaluate for complications such as ischemia or perforation 1. The treatment of sigmoid volvulus involves urgent endoscopic decompression, which is successful in 60-95% of cases, but carries a high recurrence risk 1.
- Endoscopic decompression should be performed as soon as possible, followed by sigmoid colectomy to prevent recurrence, as recommended by the most recent guidelines 1.
- For patients with peritoneal signs, perforation, or failed endoscopic decompression, emergency surgery is required, with the preferred surgical approach being sigmoid colectomy with primary anastomosis when feasible, or Hartmann's procedure in unstable patients 1.
- The decision to perform an isolated sigmoid colectomy versus a high anterior resection should be individualized, with consideration of the vascular supply of the remnant colon and the overall condition of the patient 1. Key considerations in the management of sigmoid volvulus include:
- Prompt resuscitation with IV fluids, electrolyte correction, and nasogastric tube placement for decompression
- Urgent endoscopic decompression to untwist the colon
- Sigmoid colectomy to prevent recurrence
- Emergency surgery for patients with peritoneal signs, perforation, or failed endoscopic decompression
- Individualized decision-making regarding the surgical approach, with consideration of the patient's overall condition and the vascular supply of the remnant colon.
From the Research
Diagnosis of Sigmoid Volvulus
- Sigmoid volvulus can be diagnosed using plain X-ray of the abdomen 2
- Computed tomography (CT) can also be used to confirm the clinical impression of sigmoid volvulus and rule out complications such as ischemia or perforation 3
- Lower gastrointestinal endoscopy can be diagnostic in all cases of sigmoid volvulus 4
Treatment of Sigmoid Volvulus
- Endoscopic management is an option for treating sigmoid volvulus, particularly in uncomplicated cases 2, 3, 4
- Endoscopic detorsion can be performed using flexible endoscopy or unsedated water-immersion colonoscopy 3, 5
- Elective sigmoid resection with primary anastomosis may be required to prevent recurrence 3, 6
- Emergency surgical detortion, primary resection, and Hartman procedure may be necessary in complicated cases 2
- Mortality rates for different treatment options vary, with elective resection having a mortality rate of 7.6% and emergency surgical procedures having higher mortality rates 2