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Sigmoid Volvulus
Sigmoid volvulus occurs when the last part of the colon twists on itself,
causing obstruction and compromising the blood supply to the colon.
What Is Sigmoid Volvulus?
E
The sigmoid colon is an S-shaped part of the colon that is in the left IN Formation of a Sigmoid Volvulus
LARG ST
E INTE The sigmoid colon is an S-shaped portion
lower side of the abdomen, above the rectum. With age, this part of
of the large intestine near the end of the
the colon or its attachments to the abdominal wall stretch out, allow- digestive tract.
Sigmoid
ing it to twist on itself, similar to the twisting of a long balloon, result- arteries As a person ages, the sigmoid colon
ing in a volvulus. When this happens, the colon becomes blocked. In and its attachments can stretch out,
addition, the blood supply may be reduced, leading to injury or death allowing it to twist around itself.
of the tissues of that part of the colon. If not treated quickly, this can Sigmoid 1
Rectum
colon
result in a perforation, a hole in the bowel through which stool and 2
gas can spill into the abdomen. Perforations can be fatal without ur-
gent intervention. Older age, chronic constipation, and living in a nurs-
ing home increase the risk of having sigmoid volvulus.

Symptoms of Sigmoid Volvulus

Patients commonly experience one or several days of lower abdomi- 3 The twisting forms a volvulus
nalpain,bloating,constipation,lackofpassinggas,andsometimesnau- that traps intestinal contents
(gas and stool) and becomes
sea and vomiting. Because the sigmoid colon is twisted on itself, stool enlarged and painful.
andgascannotpassbeyonditandthebowelbecomesobstructed.The V O LV U L U S

physicalexaminationandhistoryforapatientwithaswollentenderab-
domenandconstipationmayindicatesigmoidvolvulus.Laboratorytest
results may be normal or show signs of infection if the blood supply to
the sigmoid colon is compromised. An abdominal x-ray scan may show A perforation (hole) can occur,
causing intestinal contents to
a large dilated colon or air within the abdomen outside the intestine if leak into the adbodmen.
thereisperforation.Acomputedtomographyscanoracontrastenema
Impaired blood supply
through the rectum may also be used to confirm the diagnosis. (ischemia) can cause
injury or death to the
sigmoid colon.
Treatment
Sigmoid volvulus is considered a medical emergency and should
prompt immediate treatment. If the colon is twisted and the blood
A volvulus causes the
supply is intact, then a colonoscopy may be performed to untwist abdomen to distend and
the colon. This usually resolves the blockage quickly. However, this become tender to the touch.
is only a temporary solution because the risk of the sigmoid twist-
ing on itself again is high. Patients who are successfully treated with or other patient factors may also increase the risk of needing to have
a colonoscopy should undergo elective surgery to remove the sig- a colostomy. There are no means to prevent sigmoid volvulus, and
moid colon during the same hospital stay. This can usually be done prophylactic surgery is not recommended.
without need for a colostomy (a surgical opening to divert the in-
testine). If the colon has been without adequate blood flow for too
FOR MORE INFORMATION
long or perforation of the bowel has occurred, then the patient should
Mayo Clinic
undergo emergency surgery to remove the sigmoid colon. In these www.mayoclinic.org/diseases-conditions/intestinal-obstruction/
situations, the risk of needing to have a colostomy is higher. Simi- symptoms-causes/syc-20351460
larly, a history of previous surgeries, overall health and nutrition,

Authors: Ioana Baiu, MD, MPH; Andrew Shelton, MD The JAMA Patient Page is a public service of JAMA. The information and
Author Affiliations: Stanford Hospital, Stanford, California (Baiu); Stanford University recommendations appearing on this page are appropriate in most instances, but they
School of Medicine, Stanford, California (Shelton). are not a substitute for medical diagnosis. For specific information concerning your
personal medical condition, JAMA suggests that you consult your physician. This page
Conflict of Interest Disclosures: None reported. may be photocopied noncommercially by physicians and other health care
Sources: Johansson N, Rosemar A, Angenete E. Risk of recurrence of sigmoid professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
volvulus: a single-centre cohort study. Colorectal Dis. 2018;20(6):529-535.
doi:10.1111/codi.13972
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(4):489-497.

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