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Saturday, November 5, 2022

Sigmoid Volvulus

EemDOCs / EM@3AM - By Tony Mathew and Taylor Terlizzese - November 05, 2022
Reviewed by: Sophia Görgens; Cassandra Mackey and Brit Long
Pearls:
  • Patients with suspected sigmoid volvulus that present with symptoms of bowel gangrene or perforation – hemodynamic instability, fever, obstipation, abdominal rigidity – require emergent surgical intervention. Manage ABCs, administer IV fluids and broad-spectrum
  • Plain films are sensitive but are not specific for sigmoid volvulus. Look for the classic ‘coffee bean sign’. CT non-contrast can be used to confirm sigmoid volvulus or identify alternative causes of LBO. 
  • Prognosis of sigmoid volvulus is good if detected early with initial treatment of endoscopic decompression via sigmoidoscopy. However, high rates of recurrence and high mortality is associated with solely non-operative reductions.
  • Gold standard treatment for sigmoid volvulus involves elective resection of the sigmoid colon and anastomosis (ELRSA).