Uncomplicated Sigmoid Volvulus: Next Step When Endoscopic Detorsion Fails to Resolve the Volvulus

This protocol applies to uncomplicated sigmoid volvulus in a patient who is not in extremis, without clinically or radiologically suspected colonic ischemia, perforation, peritonitis, or septic shock — where the initial endoscopic approach has not achieved resolution.

Clinical Scenario

Sigmoid volvulus (uncomplicated) — patient not in extremis; no clinically or radiologically suspected colonic ischemia; no colonic perforation; no peritonitis; no septic shock.

Previous Step and Why It Was Not Sufficient

First-line treatment did not achieve its goal

The initial approach was urgent flexible endoscopic detorsion of the sigmoid colon, including endoscopic assessment of mucosal viability and placement of a decompression flatus tube after detorsion. The goal of that step — successful endoscopic decompression with full resolution of the volvulus — was not met. This protocol defines the next management step.

Treatment Approach

When endoscopic decompression does not achieve resolution of the volvulus, a surgical intervention directed at the sigmoid colon is indicated. The clinical situation and findings guide the urgency and approach. The complete algorithm — including indications, timing, and operative considerations — is available in the full protocol…

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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.

Urgent sigmoid resection is indicated when endoscopic detorsion of the sigmoid colon is not successful and in cases of non-viable or perforated colon.

For patients with successful endoscopic decompression, sigmoid colectomy should be offered to prevent recurrent volvulus.

The colectomy should be performed as early as possible, even during the index admission.

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