Management of Sigmoid Volvulus: A Literature Review

Sigmoid volvulus (SV) is a rare form of intestinal obstruction in which the sigmoid colon twists around its own base. Endoscopic detorsion is the primary treatment in uncomplicated patients, while urgent surgery is required in the cases with bowel perforation, peritonitis, and unsuccessful endoscopic detorsion. In surgery, the gangrenous sigmoid colon is managed by resection, whereas sigmoid detorsion alone or with an additional recurrence-reducing procedure is applied in patients with viable bowel. However, the risk of recurrence following endoscopic or operative detorsion alone is as high as 90% with a risk of mortality up to 35%. To prevent or reduce SV recurrence, some selected cases require emergent or elective recurrence-preventive management including sigmoidopexy, mesopexy, mesoplasty, extraperitonealization, sigmoidectomy, and endoscopic percutaneous sigmoidopexy. However, the indications, techniques, and results of the above-mentioned procedures are controversial. In this review, the treatment options of SV and patient selection criteria for recurrence-preventive treatments are discussed.