Appropriate treatment of acute sigmoid volvulus in the emergency setting.
OBJECTIVE
To investigate an appropriate strategy for the treatment of patients with acute sigmoid volvulus in the emergency setting.


METHODS
A retrospective review of 28 patients with acute sigmoid volvulus treated in the Department of Colorectal Surgery, Changhai Hospital, Shanghai from January 2001 to July 2012 was performed. Following the diagnosis of acute sigmoid volvulus, an initial colonoscopic approach was adopted if there was no evidence of diffuse peritonitis.


RESULTS
Of the 28 patients with acute sigmoid volvulus, 19 (67.9%) were male and 9 (32.1%) were female. Their mean age was 63.1 ± 22.9 years (range, 21-93 years). Six (21.4%) patients had a history of abdominal surgery, and 17 (60.7%) patients had a history of constipation. Abdominal radiography or computed tomography was performed in all patients. Colonoscopic detorsion was performed in all 28 patients with a success rate of 92.8% (26/28). Emergency surgery was required in the other two patients. Of the 26 successfully treated patients, seven (26.9%) had recurrent volvulus.


CONCLUSIONS
Colonoscopy is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus. Emergency surgery is only for patients in whom nonoperative treatment is unsuccessful, or in those with peritonitis.
Department of Colorectal Surgery, Changhai Hospital, Shanghai 200433, China.
Zheng
Z
Lou
En-Da
ED
Yu
Wei
W
Zhang
Rong-Gui
RG
Meng
Li-Qiang
LQ
Hao
Chuan-Gang
CG
Fu
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D003113:Colonoscopy / Q000009:adverse effects / Q000401:mortality; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004630:Emergencies; D005260:Female; D006801:Humans; D045822:Intestinal Volvulus / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
Colonoscopy; Emergency; Sigmoid colon; Volvulus