Year 2023 / Volume 115 / Number 4
Letter
Sigmoid volvulus management, only endoscopic devolvulation?

213-214

DOI: 10.17235/reed.2023.9488/2023

Marta García Calonge, Daniel Muíño-Domínguez, María Helena González Sánchez, Eva Barreiro Alonso,

Abstract
Intestinal obstruction due to sigmoid volvulus (SV) represents a relevant percentage of abdominal diseases presenting at the emergency department. Treatment is based on early endoscopic devolvulation (ED), followed by elective surgery as definitive treatment. A 78-year-old man institutionalized with Lewy body dementia presents with abdominal pain, distention, and absence of stool in 72 hours. Coffee bean sign was seen in abdominal x-ray. Previously, he had been admitted three times last year with recurrent SV, managed with ED succesfully. Despite the recurrence, no surgical treatment was indicated after resolution of the acute situation and recovery of intestinal transit. This time, urgent colonoscopy was performed and a 20 cm length of purplish-black (isquemic) sigmoid mucosa was observed. With these findings of stablished intestinal ischemia urgent surgical intervention was performed (sigmoidectomy and terminal “Hartmann” colostomy). Histologically, necrosis, severe ulceration and mixed inflammation was noticed in the surgical piece. The patient develops favorably during a postoperative period without incidents. Therefore, he is discharged to his center. At the moment he is asymptomatic one year after the intervention with no new episodes. Recurrency of SV after ED is up to 86% of cases. In every episode, the incidence of complications such as intestinal ischemia or perforation increases significantly, as well as urgent surgery and mortality. Definitive treatment must be surgical, sigmoidectomy and terminal anastomosis is the choice technique.
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References
1. Naveed M, Jamil LH, Fujii-Lau LL et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus. Gastrointest Endosc. 2020 Feb;91(2):228-235.
2. Vogel JD, Feingold DL, Stewart DB et al. Clinical Practice Guidelines for Colon Volvulus and Acute Colonic Pseudo-Obstruction. Dis Colon Rectum. 2016 Jul;59(7):589-600.
3. Sanz Segura P, Arguedas Lázaro Y, Sebastián Domingo JJ. Percutaneous endoscopic colostomy to treat recurrent sigmoid volvulus in an almost centenary patient. Rev Esp Enferm Dig. 2021 Jan;113(1):71-72.
4. Jackson S, Hamed MO, Shabbir J. Management of sigmoid volvulus using percutaneous endoscopic colostomy. Ann R Coll Surg Engl. 2020 Nov;102(9):654-662.
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García Calonge M, Muíño-Domínguez D, González Sánchez M, Barreiro Alonso E. Sigmoid volvulus management, only endoscopic devolvulation? . 9488/2023


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Publication history

Received: 24/01/2023

Accepted: 25/01/2023

Online First: 13/02/2023

Published: 03/04/2023

Article Online First time: 20 days

Article editing time: 69 days


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