Non-Endoscopic Decompression of Colonic Volvulus with Rectal Tubes

Abstract

Purpose: We report a series of five cases of sigmoid decompression of colonic volvulus with Salem sump tubes, Foley catheters, or other rectal tubes over the past few years. Case 1: A 95-year-old male with a history of chronic constipation was admitted with marked abdominal distension; CT scan revealed a sigmoid volvulus. A Salem sump tube was inserted per rectum with immediate release of flatus and decompression of volvulus confirmed with KUB. Subsequent colonoscopy revealed a dilated colon without a rectosigmoid mass. The patient's volvulus recurred again with decompression by rectal tube. Surgical consult was called and sigmoidectomy was planned. Case 2: A 61-year-old male presented with sigmoid volvulus with immediate colonic decompression with rectal tube. He did well for more than 1 year when he was readmitted for a sigmoid volvulus. He underwent non-endoscopic decompression with rectal tube. He had colonoscopy 2 years ago that was normal. Surgical consult was done and sigmoidectomy was planned. The remaining three patients had similar presentations having been admitted with marked abdominal distension. Imaging revealed sigmoid volvulus. All patients were decompressed with rectal tubes successfully without any complications. Colonic volvulus occurs in the sigmoid colon in 75% of cases and in the cecum in 22% of cases. Treatment has been colonoscopic decompression with or without rectal tubes. In our cases nonendoscopic decompression has been successfully attempted with rectal tubes, either Foley or Salem sump, to rapidly relieve distension without the risk of colonic perforation. Patients are more comfortable and can be prepped more thoroughly for colonoscopy. Further management, including surgery, can be done electively with the patient in a more stable condition.