EMERGENCY SURGICAL APPROACH AND THERAPEUTIC MANAGEMENT IN THE TREATMENT OF SIGMOID VOLVULUS

Abstract

Sigmoid volvulus (SV) is an abnormal twisting of the sigmoid colon and represents the third most common cause of large bowel obstruction, carrying a potential risk of ischemia, necrosis, and intestinal perforation, being more prevalent in elderly male patients. Anatomical factors such as an elongated colon (dolichosigmoid) and a narrow mesenteric base are central to its pathophysiology. The present study is a narrative literature review that analyzed the surgical and therapeutic approaches to SV. Early diagnosis is supported by plain radiography (the “coffee bean” sign), but Computed Tomography (CT) is crucial to confirm obstruction, differentiate subtypes (mesenteroaxial and organoaxial), and identify vascular compromise. Endoscopic decompression is the initial treatment of choice in the absence of peritonitis or gangrene; however, the high recurrence rate requires surgical sigmoid resection as definitive treatment. In emergency cases complicated by necrosis or perforation, immediate resection, often through the Hartmann procedure, is mandatory. Advances in minimally invasive techniques, such as single-port laparoscopy, have shown promise for frail patients and are associated with lower morbidity. Careful definition of the therapeutic approach, based on risk stratification, is fundamental for effective management.