Treatment of sigmoid volvulus

Treatment of sigmoid volvulus

Flexible sigmoidoscopy or rigid sigmoidoscopy and insertion of a flatus tube should be carried out to allow deflation of the gut. The tube should be secured in place with tape for 24 hours and a repeat radiograph taken to ensure that decompression has occurred. Success, as long as ischaemic bowel is excluded, will resolve the acute problem. In fit patients, an elective sigmoid colectomy is required. It may not be reasonable to o ff er any further treatment fol - lowing successful endoscopic decompression in elderly or unfit patients; however, if there are recurrent episodes of volvulus, the options are resection or two-point fixation with combined endoscopic/percutaneous tube insertion (gastrostomy tubes are frequently used for this purpose). When the bowel is viable, fixation of the sigmoid colon to the posterior abdominal wall may be a safer manoeuvre in inex - perienced hands. Resection is preferable if it can be achieved safely . A Paul–Mikulicz procedure is useful, particularly if ther e is suspicion of impending gangrene ( Figure 78.20 ); an alternative pr ocedure is a sigmoid colectomy and, when anas - tomosis is considered unwise, a Hartmann’s procedure with subsequent reanastomosis can be carried out.