[Sigmoid volvulus--clinical, radiological and therapeutic aspects of rare disease]

Volvulus of the sigmoid colon is a common cause of colonic obstruction in many parts of the world, mainly in developing countries and in Scandinavia, but is rare in the Western Hemisphere, where it occurs in elderly patients who often have serious coexisting diseases, especially cardiovascular and neuropsychiatric disorders. Although many patients present with the typical triad of abdominal pain, distension and constipation, the disease is correctly diagnosed only in about 62%. Diagnostic delay is due in part to the relative rarity of the illness, in part to the variety of the clinical and radiologic presentation, and it might contribute to the high mortality. Treatment consists in endoscopic decompression, whenever there are no compromised intestines, followed by an elective, sigmoid resection in otherwise healthy patients, because the risk of recurrence is high after nonoperative decompression alone. Hartmann's procedure is the safest procedure in patients with ischemic necrosis of the sigmoid colon. The site of primary resection and anastomosis with viable bowel remains controversial. Knowledge of sigmoid volvulus is of general interest with respect to the growing number of elderly patients, especially those residing in nursing homes and psychiatric institutions.