title: An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases.
abstract: OBJECTIVE
  This study was designed to review the outcomes of emergent treatment of sigmoid colon volvulus.
  
  
  METHODS
  The records of 827 patients were reviewed retrospectively.
  
  
  RESULTS
  The mean age was 57.9 years (range, 10 weeks to 98 years), and 688 patients (83.2 percent) were male. Nonoperative reduction was applied in 575 patients (barium enema in 13, rigid sigmoidoscopy in 351, and flexible sigmoidoscopy in 211, with rectal tube placement in all patients). The results were as follows: success of 78.1 percent, mortality of 0.9 percent, complication of 3 percent, and early recurrence of 3.3 percent. Surgical treatment was performed on 393 patients (detorsion in 46, mesosigmoidopexy in 56, exteriorization in 4, resection with Hartmann's procedure in 146, resection with Mikulicz procedure in 14, resection with primary anastomosis in 51, tube cecostomy and colonic cleansing with resection in 75, and laparotomy in 1). The results were as follows: mortality of 15.8 percent, complication of 37.2 percent, early recurrence of 0.8 percent, and late recurrence of 6.7 percent.
  
  
  CONCLUSIONS
  Nonoperative reduction is the initial treatment of sigmoid colon volvulus, and flexible sigmoidoscopy with rectal tube placement can be used successfully. Patients in whom bowel gangrene or peritonitis is present or nonoperative treatment is unsuccessful need emergency surgery. In surgical treatment, resection and primary anastomosis is the first choice, and it can be performed with acceptable mortality and morbidity rates if the patient is stable and a tension-free anastomosis is possible. Nondefinitive procedures have high recurrence rates; thus, definitive surgical techniques must be preferred.
authors.affiliation: Department of General Surgery, Atatürk University, School of Medicine, Erzurum, Turkey.
authors.forename: Durkaya
authors.initials: D
authors.lastname: Oren
authors.forename: S Selçuk
authors.initials: SS
authors.lastname: Atamanalp
authors.forename: Bülent
authors.initials: B
authors.lastname: Aydinli
authors.forename: M Ilhan
authors.initials: MI
authors.lastname: Yildirgan
authors.forename: Mahmut
authors.initials: M
authors.lastname: Başoğlu
authors.forename: K Yalçin
authors.initials: KY
authors.lastname: Polat
authors.forename: Omer
authors.initials: O
authors.lastname: Onbaş
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D045822:Intestinal Volvulus / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012812:Sigmoidoscopy; D016896:Treatment Outcome