Uncomplicated Sigmoid Volvulus: First-Line Management When No Ischemia, Perforation, or Peritonitis Is Present
This protocol addresses patients presenting with sigmoid volvulus who are not in extremis, with no clinical or radiological suspicion of colonic ischemia, perforation, peritonitis, or septic shock. In this setting, a specific urgent endoscopic approach is the standard first line.
Clinical Scenario
- Sigmoid volvulus — uncomplicated presentation
- Patient is not in extremis
- No clinically or radiologically suspected colonic ischemia
- No colonic perforation
- No peritonitis
- No septic shock
Treatment Approach (Partial Overview)
Management centres on urgent endoscopic intervention to decompress the obstructed sigmoid colon. The complete structured regimen — including the procedural sequence, mucosal assessment, and post-procedure steps — is available in the full protocol.
Treatment goal: Successful endoscopic decompression with resolution of the volvulus.
References
DOI: 10.1186/s13017-023-00502-x
- In patients in whom ischemia or perforation is not suspected clinically and/or radiologically, flexible endoscopy should be performed as a first line to decompress the sigmoid colon.
- Conversely, if the patient is not in extremis, and the volvulus is uncomplicated, then the first line of treatment is endoscopic decompression.
- In the absence of colonic ischemia or perforation, the initial treatment of sigmoid volvulus is urgent endoscopic detorsion, which is effective in 60–95% of patients.
- At the end of detorsion, endoscopic view of the mucosa to assess sigmoid colon viability is mandatory.
- After successful detorsion of the sigmoid colon, a decompression flatus tube should be left in place to maintain the reduction, allow for continued colonic decompression, and facilitate mechanical bowel preparation as needed.
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