RESULTS OF ENDOSCOPIC MANAGEMENT OF SIGMOID VOLVULUS

Aims:

Sigmoid volvulus (SV) is represented by the wrapping of the sigmoid colon around itself and its mesentery, causing an intestinal obstruction and ischemic changes.

Controversy exists between endoscopy and surgery for the therapeutic management of colonic volvulus in emergency.

The aim of the study is to assess the outcome of patients with SV managed by endoscopic detorsion.

Methods:

A retrospective study including patients who underwent emergency endoscopic detorsion in the gastroenterology department of Habib Thameur Hospital, between January 2008 and August 2018 was conducted. The results of endoscopic management, percentage of recurrence, and the need for surgical procedures were analyzed.

Results:

During the study period, a total of 12 patients with acute SV were endoscopically treated. There were 9 men and 3 women, with a mean age of 60,4 years [range 30 – 90]. Endoscopic treatment was successfully performed without any complication in 10 patients, representing a primary success of 83,3%. For the other cases, exsufflation could not be performed because of severity endoscopic signs of bowel ischemia requiring an immediate surgery consisting on sigmoidectomy with Bouilly-Volkmann's colostomy.

Early recurrence occurred in 2 patients an average of 16 days post detorsion [range 2 – 25 days], representing a secondary success of endoscopic treatment of 80%.

Semi-elective surgery was performed in 80% of patients who underwent endoscopic detorsion (n = 8) an average of 19,1 days [range 0 – 35].

Conclusions:

For uncomplicated SV, endoscopy is the best therapeutic option. It is safe and efficient with a high primary and secondary success rates. An elective surgery can than be performed in better conditions.