Sigmoid Volvulus: Diagnostic Modalities and Sigmoid Gangrene

Laparoscopic Sigmoid Colectomy with Natural Orifice Specimen Extraction in Sigmoid Volvulus

Sigmoid volvulus (SV), the twisting of the sigmoid colon around its own base, is a relatively rare colonic obstruction form. Endoscopic detorsion is the first-line management option in uncomplicated patients. However, recurrence risk is as high as 90%, with a risk of mortality up to 35%. Although procedures such as sigmoidopexy, sigmoidomesopexy, sigmoidomesoplasty, extraperitonealization, or percutaneous endoscopic sigmoidopexy may prevent or reduce SV recurrence, laparoscopic sigmoid colectomy with natural orifice specimen extraction appears to be the optimal choice in selected cases. Cite this article as: Atamanalp SS. Laparoscopic sigmoid colectomy with natural orifice specimen extraction in sigmoid volvulus. Eurasian J Med. Published online May 2, 2024. doi:10.5152/ eurasianjmed.2024.24420.

Endoscopic Decompression of Sigmoid Volvulus: Review of 748 Patients

Background: Sigmoid volvulus (SV) is the twisting of the sigmoid colon around itself. Endoscopy both helps diagnosis and provides treatment in the absence of peritonitis or perforation in SV. Nevertheless, there are some controversies or limitations on this subject. The aim of this study is to evaluate the current role of the endoscopic decompression in the treatment of SV. Materials and Methods: The clinical records of 1040 patients with SV treated over a 55-year period from June 1966 to July 2021 were reviewed retrospectively until June 1986 and prospectively thereafter. For each case, preoperational parameters, treatment options, and prognosis were noted. Results: Endoscopic decompression was tried in 748 patients (71.9%). The procedure was successful in 585 cases (83.2%), whereas unsuccessful in 118 (16.8%) of 703 patients (94.0%) with viable bowel. The mortality rate was 0.5% (4 patients), the morbidity rate was 1.9% (14 patients), the early recurrence rate was 5.5% (32 patients), whereas the mean hospitalization period was 34.6 hours (range: 24-96 hours). Conclusions: Despite some controversies or limitations in some subjects including the strategy in ischemic or gangrenous cases, the factors affecting the success, kind of the used instruments, technical details of the application, role of the flatus tubes, and the specific topics such as SV in childhood or pregnancy, endoscopic decompression is the first-line therapy in selected patients with SV.