Volvulus of the sigmoid colon

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Clinical Medicine

Background:

• Sigmoid volvulus is a common cause of large bowel obstruction, particularly in certain populations.
• Distinguishing between viable and gangrenous sigmoid volvulus preoperatively is clinically challenging.
• High recurrence rates necessitate effective long-term management strategies.

Purpose of the Study:

• To present a 30-year experience with sigmoid volvulus.
• To evaluate diagnostic and management strategies for sigmoid volvulus.
• To assess the efficacy of elective sigmoid resection in preventing recurrence.

Main Methods:

• Retrospective review of 121 cases of sigmoid volvulus treated at City of Memphis Hospital over 30 years.
• Analysis of diagnostic methods, including reliance on sigmoidoscopy.
• Evaluation of treatment outcomes for both conservative and surgical interventions, including elective resection and Hartmann's procedure.

Main Results:

• Sigmoidoscopy is crucial for differentiating viable from gangrenous sigmoid volvulus when clinical data is insufficient.
• Initial management involves sigmoidoscopy with colon tube insertion; operative detorsion is reserved for failed endoscopic attempts.
• Elective sigmoid resection is associated with a significant rate of recurrence, indicating a need for further management considerations.

Conclusions:

• Sigmoidoscopy is the cornerstone of diagnosis and initial management for sigmoid volvulus.
• Elective sigmoid resection is recommended to reduce recurrence, despite a persistent risk.
• Hartmann's procedure is the preferred surgical approach for gangrenous sigmoid volvulus.