The role of endoscopy in the diagnosis and treatment of sigmoid volvulus

Abstract

Sigmoid volvulus (SV) is a rare form of acute intestinal obstruction in which the sigmoid colon wraps around itself. The disease generally presents as a mechanical bowel obstruction with clinical features that are not pathognomonic. Similarly, X-ray films are not diagnostic in most cases. It is difficult to establish the correct preoperative diagnosis when CT and MRI are not used.The principal strategy in the treatment of SV in uncomplicated patients is emergency endoscopic detorsion followed by elective surgery; emergent surgery is required in patients with bowel gangrene, bowel perforation, peritonitis, or unsuccessful endoscopic treatment.In this review, we have discussed the role of sigmoidoscopy in the diagnosis and treatment of SV. Additionally, we have retrospectively and prospectively evaluated our 49-year, 987-patient clinical experience, the largest single-center SV series ever reported.

Risk of recurrence of sigmoid volvulus: a single‐centre cohort study

“…The most commonly used nonoperative method was decompression by a rectal tube, which is often performed by a radiologist. This differs from other studies, where flexible endoscope is the method of choice . The mortality rate associated with the use of a rectal tube in this study was 2.4% (10/416), which is higher than the 0.3% (1/322) found with the use of a flexible endoscope in a study by Atamanalp .…”

What is done when endoscopic examination reveals borderline bowel ischemia in patients with sigmoid volvulus?

“…Interestingly, we could not find any data or discussion material on this subject. Therefore, we evaluated our clinical records of SV patients, as well as our experiments, in the largest single-center SV series of the world 2-4,11,12. In our opinion, there are three options: emergency surgical treatment rounding out endoscopy, endoscopic detorsion followed by observation with the use of advanced diagnostic techniques, and repeated endoscopic examination following endoscopic detorsion.…”

“…SV is an uncommon disease, but its incidence is relatively high in African, Asian, Middle Eastern, South American, and Eastern and Northern European countries,1 as well as in Turkey, particularly in Eastern Anatolia,2-4 where our hospital is located.…”

Evaluation of the Primary Anastomosis Side Effects in Patients with Sigmoid Volvulus in Imam Hossein and Firoozgar Hospitals in 2014-2015

“…Devolvulation is conducted using rigid flexible sigmoidoscopy using barium enema or colonoscopy [16]. In general, endoscopic devolvulation is successful in 70-80% of cases [1].…”