WSES consensus guidelines on sigmoid volvulus management
WSES · 2023 · international
Source and licence
- Authors
- Brian W C A Tian, Gabriele Vigutto, Edward Tan et al.
- Title
- WSES consensus guidelines on sigmoid volvulus management
- Journal
- World Journal of Emergency Surgery : WJES, 2023
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC10186802
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Recommendations
- Recommendation 1Initial evaluation should include a focused history and physical examination. A full panel of blood tests including blood gas and lactate levels are also important to look for suggestions of bowel ischemia.Grade of recommendation: Strong recommendation, based on low- or very-low-quality evidence, 1C
- Recommendation 2Diagnostic imaging for sigmoid volvulus is initially based on plain abdominal radiographs, showing a classic coffee bean sign.Grade of recommendation: Strong recommendation, based on low- or very-low-quality evidence, 1C
- Recommendation 3CT imaging can be used in cases where the diagnosis is in doubt, or if ischemia or perforation is suspected.Grade of recommendation: Strong recommendation, based on low- or very-low-quality evidence, 1C
- Recommendation 4In patients in whom ischemia or perforation is not suspected clinically and/or radiologically, flexible endoscopy should be performed as a first line to decompress the sigmoid colon.Grade of Recommendation: Strong recommendation, based on low- or very-low-quality evidence, 1C
- Recommendation 5Urgent sigmoid resection is indicated when endoscopic detorsion of the sigmoid colon is not successful and in cases of non-viable or perforated colon.Strong recommendation, based on low- or very-low-quality evidence, 1C
- Recommendation 6For patients with successful endoscopic decompression, sigmoid colectomy should be offered to prevent recurrent volvulus. The colectomy should be performed as early as possible, even during the index admission.Grade of Recommendation: Strong recommendation based on low-quality evidence, 1C
- Recommendation 7Non-resectional operative procedures (detorsion, sigmoidoplasty and mesosigmoidoplasty) are inferior to sigmoid colectomy for the prevention of recurrent volvulus and should be avoided.Strong recommendation based on low-quality evidence, 1C
- Recommendation 8Endoscopic fixation of the sigmoid colon may be considered in select patients in whom operative interventions present a prohibitive risk.Grade of Recommendation: Weak recommendation based on low-quality evidence, 2C
- Recommendation 9Patients who have concomitant megacolon and sigmoid volvulus, should undergo subtotal colectomy. Sigmoid colectomy alone is insufficient as the volvulus tends to recur in the remnant segments of colon.Grade of Recommendation: Strong recommendation based on low-quality evidence, 1C
- Recommendation 10Colonic volvulus in pregnancy is rare. Treatment will require a multidisciplinary approach, taking into account the stage of pregnancy.Grade of Recommendation: Strong recommendation based on low-quality evidence, 1C
- Recommendation 11Ileosigmoid volvulus is rare and most require surgical decompression.Grade of Recommendation: Strong recommendation based on low-quality evidence, 1C
Abstract
Sigmoid volvulus is a common surgical emergency, especially in elderly patients. Patients can present with a wide range of clinical states: from asymptomatic, to frank peritonitis secondary to colonic perforation. These patients generally need urgent treatment, be it endoscopic decompression of the colon or an upfront colectomy. The World Society of Emergency Surgery united a worldwide group of international experts to review the current evidence and propose a consensus guidelines on the management of sigmoid volvulus.
Contents of the original publication
The section headings of the original.
- Background
- Purpose and use of these guidelines
- Methods
- Recommendations
- Discussion
- Conclusions
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