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).