- Richard A Hodin, MD
Richard A Hodin, MD
- Professor of Surgery
- Harvard Medical School
Volvulus refers to torsion of a segment of the alimentary tract, which often leads to bowel obstruction. The most common sites of volvulus are the sigmoid colon and cecum [1-4]. Volvulus of other portions of the alimentary tract, such as the stomach, gallbladder, small bowel, splenic flexure, and transverse colon, are rare.
This topic will review the epidemiology, pathogenesis, clinical manifestations, diagnosis, and management of sigmoid volvulus. The clinical manifestations and diagnosis of cecal volvulus are discussed separately. (See "Cecal volvulus".)
The incidence of sigmoid volvulus is not well established (picture 1). In the United States, sigmoid volvulus is a relatively uncommon cause of intestinal obstruction, representing fewer than 10 percent of cases in most series [1,5]. In contrast, sigmoid volvulus is the underlying etiology in 50 to 80 percent of patients with intestinal obstruction in other parts of the world [6-10]. (See "Chagas disease: Pathology and pathogenesis".)
Sigmoid volvulus usually occurs in older adults with a mean age of 70 years at presentation . Patients are often institutionalized and debilitated due to underlying neurologic or psychiatric disease and have a history of constipation [11-14]. Sigmoid volvulus has been reported in younger patients and in children in association with abnormal colonic motility [15-20]. (See 'Colonic dysmotility' below.)
Although some series have reported a predominance in men, others have found no difference in incidence by gender [4,13,21]. Sigmoid volvulus has been reported in patients with Crohn disease, pregnancy, and Chagas disease [8,22-24].
- Ballantyne GH, Brandner MD, Beart RW Jr, Ilstrup DM. Volvulus of the colon. Incidence and mortality. Ann Surg 1985; 202:83.
- Friedman JD, Odland MD, Bubrick MP. Experience with colonic volvulus. Dis Colon Rectum 1989; 32:409.
- Hiltunen KM, Syrjä H, Matikainen M. Colonic volvulus. Diagnosis and results of treatment in 82 patients. Eur J Surg 1992; 158:607.
- Påhlman L, Enblad P, Rudberg C, Krog M. Volvulus of the colon. A review of 93 cases and current aspects of treatment. Acta Chir Scand 1989; 155:53.
- Halabi WJ, Jafari MD, Kang CY, et al. Colonic volvulus in the United States: trends, outcomes, and predictors of mortality. Ann Surg 2014; 259:293.
- Asbun HJ, Castellanos H, Balderrama B, et al. Sigmoid volvulus in the high altitude of the Andes. Review of 230 cases. Dis Colon Rectum 1992; 35:350.
- Astini C, Falaschi CF, Mariam M, Desta A. The management of sigmoid volvulus: report of 39 cases. Ital J Surg Sci 1988; 18:127.
- Gama AH, Haddad J, Simonsen O, et al. Volvulus of the sigmoid colon in Brazil: a report of 230 cases. Dis Colon Rectum 1976; 19:314.
- Schagen van Leeuwen JH. Sigmoid volvulus in a West African population. Dis Colon Rectum 1985; 28:712.
- Udezue NO. Sigmoid volvulus in Kaduna, Nigeria. Dis Colon Rectum 1990; 33:647.
- Rosenthal MJ, Marshall CE. Sigmoid volvulus in association with parkinsonism. Report of four cases. J Am Geriatr Soc 1987; 35:683.
- Mangiante EC, Croce MA, Fabian TC, et al. Sigmoid volvulus. A four-decade experience. Am Surg 1989; 55:41.
- Baker DM, Wardrop PJ, Burrell H, Hardcastle JD. The management of acute sigmoid volvulus in Nottingham. J R Coll Surg Edinb 1994; 39:304.
- Oren D, Atamanalp SS, Aydinli B, et al. An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Colon Rectum 2007; 50:489.
- Krupsky S, Halevy A, Orda R. Sigmoid volvulus in adolescence. J Clin Gastroenterol 1987; 9:467.
- Mellor MF, Drake DG. Colonic volvulus in children: value of barium enema for diagnosis and treatment in 14 children. AJR Am J Roentgenol 1994; 162:1157.
- Sroujieh AS, Farah GR, Jabaiti SK, et al. Volvulus of the sigmoid colon in Jordan. Dis Colon Rectum 1992; 35:64.
- Atamanalp SS, Yildirgan MI, Başoğlu M, et al. Sigmoid colon volvulus in children: review of 19 cases. Pediatr Surg Int 2004; 20:492.
- Ton MN, Ruzal-Shapiro C, Stolar C, Kazlow PG. Recurrent sigmoid volvulus in a sixteen-year-old boy: case report and review of the literature. J Pediatr Surg 2004; 39:1434.
- Northeast AD, Dennison AR, Lee EG. Sigmoid volvulus: new thoughts on the epidemiology. Dis Colon Rectum 1984; 27:260.
- Isbister WH. Large bowel volvulus. Int J Colorectal Dis 1996; 11:96.
- Lashner BA, Anastaplo SM, Kirsner JB. Sigmoid volvulus as a complication of ileal Crohn's disease. J Clin Gastroenterol 1989; 11:82.
- Lord SA, Boswell WC, Hungerpiller JC. Sigmoid volvulus in pregnancy. Am Surg 1996; 62:380.
- Alshawi JS. Recurrent sigmoid volvulus in pregnancy: report of a case and review of the literature. Dis Colon Rectum 2005; 48:1811.
- Shepherd JJ. The epidemiology and clinical presentation of sigmoid volvulus. Br J Surg 1969; 56:353.
- Alver O, Oren D, Tireli M, et al. Ileosigmoid knotting in Turkey. Review of 68 cases. Dis Colon Rectum 1993; 36:1139.
- VerSteeg KR, Whitehead WA. Ileosigmoid knot. Arch Surg 1980; 115:761.
- Machado NO. Ileosigmoid knot: a case report and literature review of 280 cases. Ann Saudi Med 2009; 29:402.
- Harari D, Gurwitz JH, Minaker KL. Constipation in the elderly. J Am Geriatr Soc 1993; 41:1130.
- Sarioğlu A, Tanyel FC, Büyükpamukçu N, Hiçsönmez A. Colonic volvulus: a rare presentation of Hirschsprung's disease. J Pediatr Surg 1997; 32:117.
- Retraction. Clinical presentation and diagnosis of sigmoid volvulus: outcomes of 40-year and 859-patient experience. J Gastroenterol Hepatol 2009; 24:1154.
- Avots-Avotins KV, Waugh DE. Colon volvulus and the geriatric patient. Surg Clin North Am 1982; 62:249.
- Peoples JB, McCafferty JC, Scher KS. Operative therapy for sigmoid volvulus. Identification of risk factors affecting outcome. Dis Colon Rectum 1990; 33:643.
- Raveenthiran V. Emptiness of the left iliac fossa: a new clinical sign of sigmoid volvulus. Postgrad Med J 2000; 76:638.
- Catalano O. Computed tomographic appearance of sigmoid volvulus. Abdom Imaging 1996; 21:314.
- Levsky JM, Den EI, DuBrow RA, et al. CT findings of sigmoid volvulus. AJR Am J Roentgenol 2010; 194:136.
- Anderson JR, Lee D. The management of acute sigmoid volvulus. Br J Surg 1981; 68:117.
- Atamanalp SS. Treatment of sigmoid volvulus: a single-center experience of 952 patients over 46.5 years. Tech Coloproctol 2013; 17:561.
- Kuzu MA, Aşlar AK, Soran A, et al. Emergent resection for acute sigmoid volvulus: results of 106 consecutive cases. Dis Colon Rectum 2002; 45:1085.
- Bagarani M, Conde AS, Longo R, et al. Sigmoid volvulus in west Africa: a prospective study on surgical treatments. Dis Colon Rectum 1993; 36:186.
- Larkin JO, Thekiso TB, Waldron R, et al. Recurrent sigmoid volvulus - early resection may obviate later emergency surgery and reduce morbidity and mortality. Ann R Coll Surg Engl 2009; 91:205.
- Cowlam S, Watson C, Elltringham M, et al. Percutaneous endoscopic colostomy of the left side of the colon. Gastrointest Endosc 2007; 65:1007.
- Brothers TE, Strodel WE, Eckhauser FE. Endoscopy in colonic volvulus. Ann Surg 1987; 206:1.