ISSN ONLINE: 2558-815X
ISSN PRINT: 1584-9244
ISSN-L: 1584-9244

Non-operative management of the sigmoid volvulus – case presentation



Sigmoid volvulus happens when the sigmoid wraps around itself and its mesentery. Sigmoid volvulus accounts for 2% to 50% of all colonic obstructions. This pathology generally affects adults, and it is more common in males. The etiology is multifactorial and controversial; the main symptoms are diffuse abdominal pain, distention and constipation, while the pregnant signs are abdominal distention and tenderness. Laboratory findings are not pathognomonic: abdominal X-ray radiographs show a dilated sigmoid colon and multiple intestinal air-fluid levels, abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy reveals a spiral sphincter-like twist of the mucosa. The diagnosis of sigmoid volvulus is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation, or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definitive or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful non-operative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%.

Keywords: sigmoid volvulus, non-operative management of volvulus.

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Address for correspondence:
Bogdan SOCEA
Emergency Clinical Hospital “Sfântul Pantelimon” General Surgery Clinic
Address: Șoseaua Pantelimon no. 340-342, 1st floor, Bucharest, Romania
Email:; Phone: +40788491091; Fax: +40212550064


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Socea B, Smaranda AC, Nica AA, Bratu OG, Diaconu CC, Baleanu VD, Moculescu CE, Dimitriu M, Carap AC, Bobic S, Constantin VD. Non-operative management of the sigmoid volvulus - case presentation. Arch Balk Med Union 2018;53(4):619-622. DOI 10.31688/ABMU.2018.53.4.24