Sigmoid Volvulus

A twisting of the sigmoid colon around its mesentery, leading to bowel obstruction and potential ischaemia.

• Chronic constipation
• Neurological or psychiatric conditions
• Elderly or institutionalised population
• High-fibre diet (observed in some populations)

• Abrupt onset of severe abdominal pain.
• Distension, particularly in the lower abdomen.
• Constipation and absence of flatus.
• Vomiting (may become faeculent if not promptly treated).
• Examination will reveal a tympanitic, tender abdomen.

• Plain abdominal X-ray:

  • “Coffee bean” or “omega loop” sign.
  • Distended sigmoid loop pointing to the right upper quadrant.
• CT Scan:
  • Confirms diagnosis and assess for bowel ischaemia.

• Blood tests:

  • May show raised white cells, lactate (if ischaemia present).

• Initial: 

  • Resuscitation with IV fluids.
  • Nasogastric tube insertion to decompress the stomach/GI tract.
  • Antibiotics if signs of systemic infection or ischaemia.
• Definitive:
  • Endoscopic decompression (sigmoidoscopy):

    • • First-line for most patients.
    • • May be followed by elective sigmoid colectomy to prevent recurrence.

• • Surgery:

    • • Required if there’s suspicion of bowel ischaemia, perforation, or failed non-surgical decompression.
    • • Sigmoid colectomy is the procedure of choice.

• Bowel ischaemia or gangrene.
• Perforation leading to peritonitis.
• Recurrence if definitive surgical management is not undertaken.

• Prompt diagnosis and treatment lead to favourable outcomes.
• Risk of morbidity and mortality increases with delayed intervention, especially if bowel ischaemia occurs.