Management of Sigmoid Volvulus: A Literature Review

Abstract

Sigmoid volvulus (SV) is a rare form of intestinal obstruction in which the sigmoid colon twists around its own base. Endoscopic detorsion is the primary treatment in uncomplicated patients, while urgent surgery is required in the cases with bowel perforation, peritonitis, and unsuccessful endoscopic detorsion. In surgery, the gangrenous sigmoid colon is managed by resection, whereas sigmoid detorsion alone or with an additional recurrence-reducing procedure is applied in patients with viable bowel. However, the risk of recurrence following endoscopic or operative detorsion alone is as high as 90% with a risk of mortality up to 35%. To prevent or reduce SV recurrence, some selected cases require emergent or elective recurrence-preventive management including sigmoidopexy, mesopexy, mesoplasty, extraperitonealization, sigmoidectomy, and endoscopic percutaneous sigmoidopexy. However, the indications, techniques, and results of the above-mentioned procedures are controversial. In this review, the treatment options of SV and patient selection criteria for recurrence-preventive treatments are discussed.

Restoration of intestinal continuity following emergency sigmoid colectomy for sigmoid volvulus: An American College of Surgeons National Surgical Quality Improvement Program analysis using coarsened exact matching

“…2 First, sigmoid colectomy is the most efficacious recurrence-reducing procedure in the treatment of SV, which extinguish dolichosigmoid, the predominant anatomical prerequisite for the development of SV. 3 However, there is limited data to guide decisionmaking between primary anastomosis and stoma in the restoration of intestinal continuity. 4 In our 173-case primary anastomosis and 206-case stoma groups, the mortality and morbidity rates are 12.7% versus 24.3% and 33.5% versus 40.3%, respectively.…”

“…5 Additionally, when it comes to the emergency management of SV, pregnant women and children are other rare but controversial groups. 3 We wonder about the clinical practice and theoretical opinion of the authors in the restoration of the intestinal continuity in such circumstances.…”

“…Third, although the authors present statistically similar length of hospital stay in both groups, it is clear that, patients treated with stoma require a second hospitalization period for stoma closure. 3 Additionally, economic burden arising from stoma care material and second hospitalization are other discussion points. We inquire about the opinion of the authors on abovementioned subjects, which are not clearly identified in their presentation.…”

“…Second, although the authors' results on high‐risk cases present statistically similar outcomes in both groups, the traditional approaches and medicolegal responsibilities may force the practitioners to perform stoma in selected cases with various localized bowel findings, including perforation, borderline ischemia, edema, or different diameter in bowel ends following sigmoid colectomy, which are regarded as risk factors for primary anastomosis 5 . Additionally, when it comes to the emergency management of SV, pregnant women and children are other rare but controversial groups 3 . We wonder about the clinical practice and theoretical opinion of the authors in the restoration of the intestinal continuity in such circumstances.…”