How are endoscopic detorsion and decompression performed in patients with sigmoid and cecal volvulus?

Updated: Nov 28, 2018
  • Author: Scott C Thornton, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Recognition of the typical radiologic findings of a sigmoid volvulus on plain abdominal radiography is followed by emergency sigmoidoscopy or colonoscopy for detorsion and decompression of the volvulus.

The sigmoidoscope or colonoscope is advanced into the rectum under direct vision. The rectum is insufflated to provide good visibility and facilitate identification of the apex of the volvulus. Occasionally, the pressure of the air causes detorsion, reducing the volvulus.

If detorsion does not occur, the spiraling rectal mucosa is followed upward to the apex, and a soft rectal tube is passed up through this under direct vision. The tip of the endoscope can also be used to apply constant pressure at the apex, which can lead to detorsion and decompression.

Placement of a soft rectal tube allows continued decompression and bowel preparation before the planned surgical procedure. Placement of a rectal tube without endoscopic visualization is not advised, because of the risk of perforation. Decompression is evident through passage of large amounts of gas and fecal material but should be radiologically confirmed.


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