Sigmoid volvulus: identifying patients requiring emergency surgery with the dark torsion knot sign

Comments on ‘A tale of two twist: Mesentero‐axial and organo‐axial sigmoid volvulus’

“…If a few case reports are neglected, an electronic data search of the last 55-year literature (from 1970 to date) in Web of Science 3 database presents only two case series on organo-axial SV. Among these, Heo et al 4 reported a 61% of organo-axial SV, while this rate was 74% in the series of Bernard et al, 5 which rates were similar to that of the authors' rate, 68%. Interestingly, there was no organo-axial SV in our 478 surgically treated cases.…”

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

“…However, plain radiography has a low diagnostic sensitivity and is unable to assess blood supply or the identification of coexistent relevant pathologies [ 427 , 428 ] which is of utmost importance in determining appropriate management. Therefore, contrast‐enhanced CT scan is the gold standard allowing, in addition, the viability of the bowel to be assessed [ 429 ]. It would be reasonable to perform an abdominal X‐ray in a stable patient with a known recurrent sigmoid volvulus.…”

Large-bowel obstruction: CT findings, pitfalls, tips and tricks

“…CT signs have been assessed as ineffective for the prediction of the presence of pathologically proven ischemia until there was frank bowel necrosis (26). A newly defined CT imaging factor of ischemia has recently been described, the "dark torsion knot sign" shown as a sudden loss of mucosal enhancement in the volvulus torsion knot (33). This CT factor and a clinical factor (sepsis) were the only factors able to predict complicated volvulus sigmoid necessitating emergent surgery instead of colonoscopic detorsion as a primary treatment of choice.…”