Sigmoid Volvulus and Ileosigmoid Knotting: An Update

Abstract

Sigmoid volvulus and ileosigmoid knotting are uncommon intestinal obstructions, which generally affect adult males. The etiology is multifactorial. Volvulus triad including abdominal pain/tenderness, distention, and obstipation/constipation is the common clinical presentation. Although x-ray radiography helps with diagnosis, the current diagnostic procedure is computed tomography or magnetic resonance imaging in addition to flexible endoscopy in sigmoid volvulus. Endoscopic decompression is the primary treatment except for the presence of bowel gangrene and peritonitis in sigmoid volvulus, while such conditions and also ileosigmoid knotting require emergency surgery. The prognosis is relatively poor under these adverse circumstances and in ileosigmoid knotting.

Management of Sigmoid Volvulus: A Literature Review

“…2 5 10 14 19 22 Medium-term recurrence, within about 1 month, is 15 to 30%, while long-term recurrence rises up to 43 to 90% with a mean of 4.4 (range: 2–25) volvulus attacks. 1 2 3 5 7 8 9 12 13 14 18 23 24 25 26 27…”

“…32 35 This procedure is generally used in emergent surgery in bedridden patients, whereas it is less recommended in open or laparoscopic elective surgery due to its relatively high recurrence rate. 2 10 13 Although single-point fixation is possible, it allows for re-rotation of the sigmoid colon around apical basal line resulting in SV recurrence. For this reason, multiple-point fixation is preferred to reduce recurrence risk, which may cause increased risk of leakage.…”

“…Endoscopic detorsion is the optimal choice in uncomplicated patients in all trimesters. 2 55 56 In the first trimester, elective surgery is delayed to the second trimester, in which sigmoidectomy may be performed safely. Endoscopic decompression is the prescribed treatment in the third trimester as well until delivery and given the complexities of operating on a postgravid uterus, surgery is generally delayed to a few weeks postpartum.…”

“…SV is rare and recurrent SV is extremely rare in childhood. 2,25,29,51,52 The first-line treatment is endoscopic detorsion in children with uncomplicated SV, but it requires pediatric endoscope and expertise. 53 However, recurrence is common in adults and elders with childhood-onset SV, which is reported at a mean of 25 to 35% and up to 100%.…”

Comments on ‘The Role of Ramadan Fasting on Intestinal Volvulus and Knotting’

“…Among the discussed subjects, our comments relate to the effects of fasting on sigmoid volvulus (SV) and ileosigmoid knotting (ISK) based on our 57-year (from June 1966 to July 2023) experience including 1,071 SV patients, the most comprehensive monocenter SV data over the world, and 80 ISK cases, one of the most extensive worldwide ISK series. 2…”