Management of Acute Sigmoid Volvulus: An Institution’s Experience Over 9 Years

Abstract

Acute sigmoid volvulus is a surgical emergency, although the majority (75%) can be successfully decompressed nonoperatively. Emergency surgery in these patients is associated with a mortality of 17.6% in our series. Elective definitive surgery is suggested in view of the high recurrence rate (>60%) and the considerable risks of emergency surgery.

Colonic Volvulus

“…Other reported series have observed recurrence rates for conservatively managed sigmoid volvulus from 7.5% to more than 60%. 9,[23][24][25][26] Although this study represents a rare, recent large review of colonic volvulus in the United States, it has significant shortcomings, stemming mostly from its observational, nonexperimental, and retrospective nature. Additional limitations in the comparison of various radiographic studies and therapeutic interventions exist, because all episodes of volvulus were not provided the same studies and treatment.…”

Laparoscopy-Assisted PEC Tubes: A Novel Treatment for Sigmoid Volvulus

“…However, because of the relatively high rate of recurrence (with estimates as high as 60 -70%), the definitive treatment is bowel resection after colonic decompression. [12][13][14] Because of the invasive nature of the bowel resection procedure, other long-term treatments have been explored. In the case of our patient, the family refused any major operation that would require removal of internal organs for religious reasons.…”

Rectal volvulus following laparoscopic left hemicolectomy

“…Initial management include fluid resuscitation, nasogastric sunction and analgesia 3 7. Conservative management involves using a flatus tube and/or sigmoidoscope decompression in uncomplicated patients 3 7.…”

“…Conservative management involves using a flatus tube and/or sigmoidoscope decompression in uncomplicated patients 3 7. If these fail or evidence of gangrenous bowel, then emergency laparotomy is required 2.…”