Sigmoid Volvulus: A New Twist to an Old Problem

Abstract

Reports of a volvulus (twisting) of the sigmoid colon can be found in a papyrus from ancient Egypt. However, sigmoid volvulus represents a spectrum of disease across the globe from young men in central Africa to the elderly institutionalised patients in Western Europe and the USA. As the population ages the prevalence of sigmoid volvulus is likely to rise. As an acute presentation, it represents a multidisciplinary challenge in its management, because whilst surgery is a definitive cure, this has to be balanced against co-existing morbidity. In the chronic or recurrent case, definitive treatment must again be tailored to the ‘fitness’ of the patient to minimise an acute recurrence with its inherent increased morbidity and mortality.In this review we have looked at the results of the published series for the different management options, which may be surgical or endoscopic. We have proposed an algorithm for the management of an acute or chronic sigmoid volvulus within the multidisciplinary team setting.