Sigmoid volvulus has been described since ancient times, but its treatment is still evolving. Several surgical approaches have been used including, resection, non-operative reduction using a colonoscope, sigmoidopexy and mesosigmoidoplasty. There is no consensus at present with regard to the optimal surgical management in an acute situation. RPA has emerged as the treatment of choice for sigmoid volvulus over the past two centuries. However, using this approach, anastomotic leakage may occur in the elderly and hemodynamically unstable patients with sigmoid volvulus. Symptomatic anastomotic leakage is the most important postoperative complication following emergency colorectal resection with intestinal anastomosis.
A research article to be published on September 28, 2008 in the World Journal of Gastroenterology addresses this question. The research team led by Prof. Coban from Gaziantep University and Prof. Kirimlioglu from Inonu University used a modified proximal decompressive blow-hole colostomy to prevent anastomotic leak. Proximal decompressive blow-hole colostomy has been used previously in patients with toxic megacolon secondary to inflammatory bowel disease and clostridium difficile colitis to avoid manipulating the colon and to tide the patients through the critical phase. Due to co-morbid risk factors, particularly in patients presenting with gangrenous sigmoid volvulus, the addition of a modified blow-hole colostomy appears to be a promising procedure to prevent anastomotic leak. The aim of the present study was to compare the results of RPA with or without modified blow-hole colostomy in unprepared bowel with acute sigmoid volvulus.
From March 2000 to September 2007, 47 patients who underwent RPA with or without modified blow-hole colostomy were included in this study. In 25 patients, RPA (Group A) was performed and in the remaining 22 patients underwent modified blow-hole colostomy with RPA (Group B). All the anastomoses were inverting and two-layered.
Superficial wound infection were almost four times more common in group A (32% vs 9.1%), and nearly two times more common in the patients with a viable colon. Three patients (12%) developed anastomotic leak in group A. There was no clinical anastomotic leak in group B. The time to resumption of diet was on postoperative day 4 in group A, and on day 1 in group B due to the presence of a protective stoma.
RPA with modified blow-hole colostomy provides satisfactory results in patients with sigmoid volvulus. This procedure has been shown to be safe and effective in preventing anastomotic leak, and may become the method of choice in patients with sigmoid volvulus. However, further studies are required to conclusively establish its role in sigmoid volvulus.