Endoscopic Decompression, Detorsion, and Reduction of Sigmoid Volvulus

Background

Colonic volvulus is a loop of bowel twisted around the site of mesenteric attachment leading to bowel obstruction. The sigmoid colon is involved in a majority of these cases. If untreated, sigmoid volvulus leads to bowel ischemia, perforation, sepsis, and potential death.

Patients and methods

In this video manuscript, we present two patients with uncomplicated sigmoid volvulus that were successfully managed by emergent endoscopic decompression, detorsion, and reduction (EDDR) and temporary colon decompression tube placement as a bridge therapy to elective and definitive surgical interventions. Detailed endoscopic evaluation and techniques are described. In addition, classic radiological findings such as the “coffee bean” sign on plain radiograph and the “whirl” sign on computed tomography are shown.

Results

After successful EDDR with subsequent bowel preparation and medical resuscitation, both patients underwent elective surgical resection of the sigmoid colon with primary anastomosis without post-operative complications.

Conclusions

Sigmoid volvulus is a medical emergency and diagnosis requires a high index of suspicion. Emergent EDDR and decompression tube placement should be utilized as a first line treatment for patients with uncomplicated sigmoid volvulus.