Published online Aug 14, 2013. doi: 10.3748/wjg.v19.i30.4979
Revised: July 4, 2013
Accepted: July 9, 2013
Published online: August 14, 2013
AIM: To investigate an appropriate strategy for the treatment of patients with acute sigmoid volvulus in the emergency setting.
METHODS: A retrospective review of 28 patients with acute sigmoid volvulus treated in the Department of Colorectal Surgery, Changhai Hospital, Shanghai from January 2001 to July 2012 was performed. Following the diagnosis of acute sigmoid volvulus, an initial colonoscopic approach was adopted if there was no evidence of diffuse peritonitis.
RESULTS: Of the 28 patients with acute sigmoid volvulus, 19 (67.9%) were male and 9 (32.1%) were female. Their mean age was 63.1 ± 22.9 years (range, 21-93 years). Six (21.4%) patients had a history of abdominal surgery, and 17 (60.7%) patients had a history of constipation. Abdominal radiography or computed tomography was performed in all patients. Colonoscopic detorsion was performed in all 28 patients with a success rate of 92.8% (26/28). Emergency surgery was required in the other two patients. Of the 26 successfully treated patients, seven (26.9%) had recurrent volvulus.
CONCLUSION: Colonoscopy is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus. Emergency surgery is only for patients in whom nonoperative treatment is unsuccessful, or in those with peritonitis.
Core tip: Early and correct diagnosis of acute sigmoid volvulus is essential for appropriate treatment aimed at correcting abnormal pathophysiological changes and restoring intestinal transit caused by the volvulus. There is still much debate as to the ideal management of sigmoid volvulus. The results of this study suggest that colonoscopic decompression and derotation is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus and is a safe treatment modality for recurrent sigmoid volvulus. Emergency surgery is required for patients in whom nonoperative treatment is unsuccessful, or in those with peritonitis, bowel gangrene or perforation.