WSES consensus guidelines on sigmoid volvulus management (2023)

Recommendation 2: Diagnostic imaging for sigmoid volvulus is initially based on plain abdominal radio- graphs, showing a classic coffee bean sign. Grade of recommendation: Strong recommendation, based on low- or very-low-quality evidence, 1C.

Recommendation 3: CT imaging can be used in cases where the diagnosis is in doubt, or if ischemia or perforation is suspected. Grade of recommendation: Strong recommendation, based on low- or very-low- quality evidence, 1C

Recommendation 4: In patients in whom ischemia or perforation is not suspected clinically and/or radiologically, flexible endoscopy should be performed as a first line to decompress the sigmoid colon. Grade of Recommendation: Strong recommendation, based on
low- or very-low-quality evidence, 1C.

Recommendation 5: Urgent sigmoid resection is indicated when endoscopic detorsion of the sigmoid colon is not successful and in cases of non-viable or perforated colon. Strong recommendation, based on low- or very-low-quality evidence, 1C.

Recommendation 6: For patients with success- ful endoscopic decompression, sigmoid colectomy should be offered to prevent recurrent volvulus. The colectomy should be performed as early as possible, even during the index admission. Grade of Recom- mendation: Strong recommendation based on low- quality evidence, 1C.

Recommendation 7: Non-resectional operative procedures (detorsion, sigmoidoplasty and mesosig- moidoplasty) are inferior to sigmoid colectomy for the prevention of recurrent volvulus and should be avoided. Strong recommendation based on low-quality evidence, 1C.

Recommendation 8: Endoscopic fixation of the sig- moid colon may be considered in select patients in whom operative interventions present a prohibitive risk. Grade of Recommendation: Weak recommenda- tion based on low-quality evidence, 2C.

Recommendation 9: Patients who have concomi- tant megacolon and sigmoid volvulus, should undergo subtotal colectomy. Sigmoid colectomy alone is insuf- ficient as the volvulus tends to recur in the remnant segments of colon. Grade of Recommendation: Strong recommendation based on low-quality evidence, 1C.

Recommendation 10: Colonic volvulus in pregnancy is rare. Treatment will require a multidisciplinary approach, taking into account the stage of pregnancy. Grade of Recommendation: Strong recommendation based on low-quality evidence, 1C.

Recommendation 11: Ileosigmoid volvulus is rare and most require surgical decompression. Grade of Recommendation: Strong recommendation based on low-quality evidence, 1C.