Patients with sigmoid volvulus who are considered unfit for abdominal operations — due to prohibitive operative risk — present a distinct management challenge. This scenario is encountered particularly in older patients or those whose overall condition places conventional surgical intervention beyond safe limits.
Sigmoid volvulus in the setting of prohibitive operative risk or inability to safely undergo abdominal surgery. In carefully selected patients from this group, endoscopic fixation approaches may be considered as an alternative to standard operative management.
An endoscopic fixation technique targeting the sigmoid colon — aimed at restricting colonic mobility to prevent recurrent volvulus — forms the basis of this pathway. The complete structured regimen, including procedural specifics, selection criteria, and full algorithm, is available in the full protocol.
DOI: 10.1186/s13017-023-00502-x
Endoscopic fixation of the sigmoid colon may be considered in select patients in whom operative interventions present a prohibitive risk.
Sigmoid volvulus is often encountered in older patients, some of whom may be unfit for abdominal operations.
In high-risk patients, endoscopic fixation of the colon (percutaneous endoscopic colostomy) can be considered.
The percutaneous endoscopic colostomy (PEC) technique is performed to fix the sigmoid colon to the anterior abdominal wall, restricting its mobility, with the aim of preventing recurrent volvulus.
Fixation of the colon has been performed using T fasteners or by percutaneous tube colostomy placement with or without laparoscopic assistance.
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