Spontaneous untwisting in sigmoid volvulus--the case for 'prophylactic' surgery. A report of 3 cases

Sigmoid volvulus may present in different ways, ranging from a dramatic acute onset to recurrent minor episodes, with symptoms varying in degree of severity in between. In elderly patients and those who already have gangrene of the colon at presentation, the operative morbidity and mortality are high. It has been suggested that perhaps half the patients presenting with acute sigmoid volvulus have a history of previous mild recurrent attacks that have reduced spontaneously. It should be possible to recognise these episodes of subclinical volvulus and to institute treatment before the development of obstruction or possible gangrene. In the 3 cases presented here, features suggestive of subclinical volvulus, viz. abdominal pains, distension, constipation and dramatic passage of flatus are highlighted. Redundant sigmoid colon on barium enema, plus the clinical features mentioned, are virtually diagnostic, and prophylactic surgery is justified to avoid the mortality and morbidity associated with established cases of sigmoid volvulus.