Tx for uncomplicated sigmoid volvulus?

Tx for uncomplicated sigmoid volvulus?

• A. Detorsion with flexible sigmoidoscopy/colonoscopy and rectal tube
• B. Immediate colectomy
• C. Endoscopic detorsion without post-detorsion observation
• D. Nasogastric tube only

Answer: (A)

In uncomplicated sigmoid volvulus, the priority is to relieve the obstruction quickly and safely while assessing bowel viability. Endoscopic detorsion with flexible sigmoidoscopy or colonoscopy accomplishes this by untwisting the twisted sigmoid and decompressing the dilated segment, which often resolves the obstruction and allows the bowel to regain perfusion if there isn’t necrosis. After detorsion, placing a rectal decompression tube helps keep the lumen open, reduces immediate recurrence risk, and provides a conduit to monitor for ongoing issues. Although detorsion alone can relieve the acute obstruction, recurrence is common if the redundant sigmoid colon isn’t addressed definitively. Therefore, plan an elective sigmoid colectomy after stabilization to prevent future episodes. If there are signs of ischemia, perforation, or peritonitis, emergent surgical resection rather than endoscopic management is required. Nasogastric decompression alone won’t resolve the obstructive twist, so it’s not the preferred definitive approach in this setting.

In uncomplicated sigmoid volvulus, the priority is to relieve the obstruction quickly and safely while assessing bowel viability. Endoscopic detorsion with flexible sigmoidoscopy or colonoscopy accomplishes this by untwisting the twisted sigmoid and decompressing the dilated segment, which often resolves the obstruction and allows the bowel to regain perfusion if there isn’t necrosis. After detorsion, placing a rectal decompression tube helps keep the lumen open, reduces immediate recurrence risk, and provides a conduit to monitor for ongoing issues.

Although detorsion alone can relieve the acute obstruction, recurrence is common if the redundant sigmoid colon isn’t addressed definitively. Therefore, plan an elective sigmoid colectomy after stabilization to prevent future episodes. If there are signs of ischemia, perforation, or peritonitis, emergent surgical resection rather than endoscopic management is required. Nasogastric decompression alone won’t resolve the obstructive twist, so it’s not the preferred definitive approach in this setting.