Volvulus of the sigmoid colon

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Epidemiology

Background:

• Sigmoid volvulus (SV) is a significant cause of acute colonic obstruction globally, particularly in South America, Africa, Eastern Europe, and Asia.
• It is notably less common in developed nations, highlighting distinct geographic variations in incidence and presentation.
• Understanding these variations is crucial for effective management strategies.

Purpose of the Study:

• To review the current status of sigmoid volvulus (SV).
• To assess evolving trends in the management of SV.
• To evaluate the existing literature on SV.

Main Methods:

• Comprehensive literature search across multiple databases including PubMed, Embase, Scopus, and Google Scholar.
• Inclusion of original articles from the last 10 years, with consideration for seminal older and non-English papers.
• Manual search of relevant non-indexed journals from endemic regions.

Main Results:

• SV incidence, clinical features, prognosis, and comorbidities vary geographically, supporting distinct endemic and sporadic subtypes.
• Emergency endoscopic reduction is the primary treatment for uncomplicated SV, typically followed by elective surgery.
• Resection of the sigmoid colon remains the gold standard, with emergency resection and primary anastomosis gaining acceptance.

Conclusions:

• The evidence base for SV management is largely observational (Level 4 CEVM grading).
• Recommendations for SV management are of 'C' grade, indicating limited high-quality evidence.
• Further research, particularly randomized controlled trials, is needed to strengthen evidence-based guidelines.