What is a sigmoid volvulus?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: March 30, 2025 • View editorial policy

From the Guidelines

A sigmoid volvulus is a serious medical condition where the sigmoid colon twists around itself, causing a bowel obstruction, and requires prompt treatment to prevent complications such as bowel ischemia, perforation, peritonitis, and death. This condition occurs when the sigmoid colon, which has a mobile mesentery, twists on itself, cutting off blood supply to the affected segment and blocking the passage of stool. Symptoms of sigmoid volvulus include sudden severe abdominal pain, abdominal distension, nausea, vomiting, and inability to pass gas or stool, and it is most commonly seen in elderly patients with chronic constipation or neurological disorders 1, 2.

Diagnosis and Treatment

The diagnosis of sigmoid volvulus is typically made using imaging studies such as X-rays or CT scans, and treatment usually begins with decompression using a rectal tube or sigmoidoscopy to untwist the colon 1. However, this is often a temporary solution, and definitive treatment usually requires surgery, either to fix the twisted segment in place (sigmoidopexy) or to remove the affected portion (sigmoid colectomy) 2.

Importance of Prompt Treatment

Without prompt treatment, sigmoid volvulus can lead to serious complications, including bowel ischemia, perforation, peritonitis, and death, making it a true surgical emergency 1, 2. The recurrence rate of sigmoid volvulus after endoscopic decompression is high, ranging from 45 to 71%, and the mortality rate after conservative treatment can be as high as 36% 2.

Sigmoid colectomy is the most effective intervention at preventing recurrent volvulus, and it is recommended to perform colonic resection within the index admission of the first episode of sigmoid volvulus 2. The entire length of the redundant colon should be removed, and the decision for laparotomy versus laparoscopy should be left to the comfort of the surgeon 2. Flexible endoscopy is preferred over rigid endoscopy due to its superior diagnostic performance and lower perforation rate 1.

Key Considerations

In patients with successful endoscopic decompression, sigmoid colectomy should be offered to prevent recurrent volvulus, and the colectomy should be performed as early as possible, even during the index admission 2. The literature favors flexible endoscopy over rigid endoscopy, and sigmoid colectomy is the intervention that is most effective at preventing recurrent volvulus 1, 2.

From the Research

Definition of Sigmoid Volvulus

  • Sigmoid volvulus occurs when a portion of the sigmoid colon twists around its blood supply at the base of the mesentery, causing ischemia and necrosis 3.
  • It is a condition where the sigmoid colon wraps around itself and its mesentery 4.
  • Sigmoid volvulus is a rare form of acute intestinal obstruction in which the sigmoid colon wraps around itself 5.
  • It is also described as the twisting of the sigmoid colon around itself 6.

Causes and Risk Factors

  • In developed nations, sigmoid volvulus is most commonly a condition of elderly, bed-bound, chronically constipated individuals 3.
  • It may occur after blunt abdominal trauma, especially in individuals with underlying anatomic derangements 3.
  • The etiology of sigmoid volvulus is multifactorial and controversial 4.

Symptoms and Diagnosis

  • The main symptoms of sigmoid volvulus are abdominal pain, distention, and constipation 4.
  • The main signs are abdominal distention and tenderness 4.
  • Routine laboratory findings are not pathognomonic, but plain abdominal X-ray radiographs show a dilated sigmoid colon and multiple small or large intestinal air-fluid levels 4.
  • Abdominal CT and MRI demonstrate a whirled sigmoid mesentery, and flexible endoscopy shows a spiral sphincter-like twist of the mucosa 4.
  • The diagnosis of sigmoid volvulus is established by clinical, radiological, endoscopic, and sometimes operative findings 4.

Treatment

  • Endoscopic detorsion is the first-line recommended treatment modality in sigmoid volvulus patients who have no peritoneal irritation signs on admission 7.
  • Emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation, or for patients whose non-operative treatment is unsuccessful 4, 5.
  • Endoscopic decompression is the first-line therapy in selected patients with sigmoid volvulus 6.

References

1
Guideline

wses consensus guidelines on sigmoid volvulus management.

World Journal of Emergency Surgery, 2023

2
Guideline

wses consensus guidelines on sigmoid volvulus management.

World Journal of Emergency Surgery, 2023

3
Research

Sigmoid volvulus after trauma, an uncommon twist.

The American journal of emergency medicine, 2022

4
Research

Sigmoid volvulus.

The Eurasian journal of medicine, 2010

6
Research

Endoscopic Decompression of Sigmoid Volvulus: Review of 748 Patients.

Journal of laparoendoscopic & advanced surgical techniques. Part A, 2022

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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