Synopsis
Recognise sigmoid volvulus, distinguish viable obstruction from infarction, and connect successful detorsion with an individual plan that prevents another dangerous episode.
- In a stable patient without suspected ischaemia, perforation or peritonitis, urgent flexible endoscopic detorsion can decompress the sigmoid and inspect its mucosa.
- Peritonitis, shock, nonviable mucosa or failed detorsion requires urgent operative assessment and usually resection; do not persist with unsafe endoscopy.
- A decompression tube can maintain initial relief after detorsion, but it does not remove the anatomical tendency to twist again.
Key red flags
Constant or intensifying pain, new tenderness, guarding, shock or fever can indicate infarction or perforation. These signs require immediate senior surgical involvement. Ischaemia may develop before overt peritonitis, so their absence is not a sufficient reason to delay an otherwise concerning presentation.
Investigation priorities
Establish sigmoid twisting and look for complications that alter the decompression route.
Management branches
A sigmoid volvulus is diagnosed and bowel viability must guide treatment.
- Resuscitate, keep the patient nil by mouth and obtain senior surgical review. Shock, peritonitis, suspected infarction or perforation calls for urgent surgery; antibiotics for suspected contamination accompany source control rather than replace it.
- If the patient is stable and there is no evidence of threatened viability or perforation, arrange urgent flexible endoscopic detorsion by an experienced operator. Assess mucosa and stop if gangrene is seen or safe progress cannot be made.