Perforation in sigmoid volvulus

Q: Patient with perforation in sigmoid volvulus requires immediate? (select one)

A) resection

B) volvulus detorsed

Answer: B

The objective of this question is to highlight an important concept during the management of bowel ischemia, i.e., impending risk of reperfusion ischemia. 

Patients who develop perforation or peritonitis due to volvulus prefer to have a resection of the compromised bowel in its volvulized position. A surgeon may even decide to perform a segmental resection or even a subtotal colectomy. Hartmann's procedure is very frequently performed, i.e., no reconstruction instead of colorectal anastomosis +/- diversion due to commonly associated clinical signs in this situation such as hemodynamic instability, coagulopathy, and acidosis. Detorsion of the bowel can set up reperfusion injury.

#surgical-critical-care

Reference:

Vogel JD, Feingold DL, Stewart DB, et al. Clinical Practice Guidelines for Colon Volvulus and Acute Colonic Pseudo-Obstruction. Dis Colon Rectum 2016; 59:589.