Commentary

Volvulus is the third most common cause of colon obstruction after colorectal cancer and diverticulitis. As in this case, sigmoid volvulus is more common in the elderly and often presents with constipation. Abdominal radiography may show the classical “coffee bean” sign.

The initial treatment is endoscopic detorsion of the sigmoid volvulus. In cases without ischemia or perforation this successfully treats ~ 80 % of patients. Occasionally patients develop recurrent sigmoid volvulus, for which surgical sigmoidpexy (fixation of the sigmoid colon) is indicated. In the surgically unfit, however, a percutaneous endoscopic colostomy (PEC) can be performed, or, as in this case, placement of a Chait catheter.

It important to keep in mind that mortality from a volvulus is around 15 % – 25 %, particularly when serious complications, such as perforation and peritonitis, have developed with late, possibly too late, recognition.

Publication History

Article published online:
22 April 2020