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
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