Editing Sigmoid volvulus (section)

== '''Management''' ==

* Resuscitation
* Immediate surgery if there     are signs of peritonitis/bowel compromise
** Resect without detorting if      the bowel is strangulated, to avoid reperfusion injury
* Otherwise endoscopic     detorsion
** Can be done with either      rigid or flexi sig (flexi better, since you can see whether mucosa is      ischaemic). If you fail with rigid, can try with flexi.
** Leave a rectal tube in situ,      attached to a bag
** Successful in 60-90% of      patients, although 70% have recurrence, so should have definitive      operation in initial hospitalization. More likely to fail with caecum      >10cm or gangrene. Aim to operate within 24-48 hours if successful.      Operate immediately if unable to decompress endoscopically.
* Definitive operation
** Get stoma marked if possible
** Lower midline laparotomy      (some say LIF muscle-splitting incision is less morbid and just as easy)
** Hartmann's procedure if      systemically compromised (50% need it)
** Primary anastomosis if well      +/- covering ileostomy
** May require subtotal      colectomy if LBO is compromising proximal colon
* Non-resectional surgery
** Inferior - not recommended
** Percutaneous endoscopic      colostomy and percutaneous endoscopic sigmoidopexy are reserved for      selected non-operative candidates, having had multiple recurrences. High      incidence of complications.

[[Category:Colorectal]]