Sigmoid volvulus: Surgical intervention or conservative management?

Aims: Sigmoid Volvulus is the most common form of volvulus of the gastrointestinal tract and accounts for 8% of intestinal obstruction. There are no specific guidelines and non-definitive management has high recurrence rates. Our aim was to review current practice over a 5 year period.

Methods: 20 patients were identified through clinical coding to have a diagnosis of sigmoid volvulus (age range 48–97 years). Each underwent restrospective review of management.

Results: 14 (70%) were treated conservatively with either flatus tube insertion or flexible sigmoidoscopy. 6 (30%) underwent definitive surgical intervention (2 with primary anastomosis, 3 end colostomy, 1 loop colostomy). Mean survival in those treated conservatively (age range 76–97) was 363 days (30%). 4 patients died on 1^st admission, 6 patients died on subsequent admissions. Of those who died, 6 (60%) had a diagnosis of dementia, one which had treatment with recurrent sigmoidoscopy over a course of 22 months. Of those treated by surgical intervention (age range 48–86), survival was 100% based on mean survival of 630 days at time of review, none of which had readmission after surgery.

Conclusion: There is an urgent need for guidelines for management of patients with sigmoid volvulus, however, surgical intervention should be preferred choice of definitive management. Yassaie et al recently showed high recurrence rate in conservative treatment, and favours the role of surgery. It is unclear of the role of repeat endoscopic decompression, and its role is one to be considered in patients who may not be suitable for surgery or in those who may not be able to manage a stoma.