Oren et al reported an algorithm for the management of a patient with sigmoid colon volvulus. This can help guide the operative management of these patients. The authors are from Ataturk University in Erzurum, Turkey.
Patient selection: sigmoid colon volvulus
Parameters:
(1) clinical diagnosis about gangrene (with or without perforation): absent, suspected or present
(2) gangrenous bowel at surgery
(3) patient risk: good or bad
Clinical Diagnosis |
Gangrenous Bowel or Perforation |
Patient Risk |
Management |
absent |
NA |
NA |
nonoperative |
suspected or present |
present |
good |
emergent surgery 1 |
suspected or present |
present |
poor |
emergent surgery 2 |
suspected or present |
absent |
good |
emergent surgery 3 |
suspected or present |
absent |
poor |
emergent surgery 4 |
Management |
Details |
nonoperative |
flexible endoscopy with elective surgery if successful else emergency surgery if unsuccessful |
emergent 1 |
resection and primary anastomosis |
emergent 2 |
resection and stoma |
emergent 3 |
(resection and primary anastomosis) OR (mesopexy, mesoplasty) |
emergent 4 |
detorsion with close monitoring |
Specialty: Gastroenterology, Surgery, general