Hi doctor,My father recently had sigmoid volvulus. His colon was untwisted during a sigmoidoscopy. However, we understand that without surgery there is a high recurrence rate which we are concerned about. We have been told the two treatment options are A) Securing the bowel to the mesentery. B) Removing the short section of the bowel that is prone to twisting. My questions are if a short section of bowel is removed is a colostomy bag always fitted, or can it be done without one? When a colostomy is later reversed and the two sections of the colon are connected back together, does not this present the same problem of feces passing through a section of the bowel which has been operated on before it has had time to heal? So, what is the point of fitting the colostomy bag in the first place?
Hello. The treatment of sigmoid volvulus depends on the general health of the patient and the nature of presentation. In an elderly patient, with multiple comorbid illnesses or who are unfit for anesthesia, the preferred modality is endoscopic (colonoscopic). The recurrence rate of this has to be accepted. If the patient is fit for surgery, it can be either suture fixed or resected (The redundant segment). In an unstable patient, especially in an emergency, the chances of healing will be less. Then a stoma is opted for temporary diversion, in order to facilitate a safe anastomosis of intestine later. In relatively stable patient, an upfront primary joining of intestine ends can be done. The proper healing of the same will allow smooth passage of contents. A stoma is not always needed. It is used only when a primary anastomosis is unsafe. The present scenario: endoscopy is the safest option considering age and comorbid. Avoid constipation at any cost, as it predisposes to volvulus. Hope your queries have been cleared. For more information consult a general surgeon online -->