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Homepage: EMNote.org ■ 🚩Membership: https://tinyurl.com/joinemnote 🚩ACLS Lecture: https://tinyurl.com/emnoteacls Sigmoid Volvulus Sigmoid volvulus = twisting of sigmoid colon around its mesentery Causes a closed-loop bowel obstruction, impairing blood flow Risk of ischemia and perforation if untreated --- Risk Factors for Sigmoid Volvulus Chronic constipation increases colonic redundancy High-fiber diets lead to bulky stool and colon distension Institutionalization (e.g., nursing homes) due to immobility and chronic constipation Congenital conditions like Hirschsprung’s disease predispose to volvulus --- Clinical Presentation Progressive abdominal distension and pain Nausea, vomiting, and constipation or obstipation Symptoms may develop gradually, especially in elderly patients Cognitive impairment may delay symptom recognition --- Diagnostic Imaging Abdominal X-ray: "Coffee bean sign" — massively dilated sigmoid loop CT scan: "Whirl sign" — twisted mesentery visible Imaging is critical for early diagnosis and management planning --- Management Approach Initial step: Endoscopic decompression in stable patients High recurrence rate after non-surgical decompression Definitive treatment: Surgical resection (e.g., sigmoid colectomy) Emergency surgery required if signs of peritonitis or decompression failure --- Prognosis and Key Points Mortality increases significantly with bowel ischemia or perforation Early diagnosis and timely intervention are critical to survival Recurrence risk necessitates planning for definitive surgical management