Sigmoid volvulus and ileosigmoid knotting are uncommon intestinal obstructions, which generally affect adult males. The etiology is multifactorial. Volvulus triad including abdominal pain/tenderness, distention, and obsti pation/constipation is the common clinical presentation. Although x-ray radiography helps with diagnosis, the current diagnostic procedure is computed tomography or magnetic resonance imaging in addition to flexible endoscopy in sigmoid volvulus. Endoscopic decompression is the primary treatment except for the presence of bowel gangrene and peritonitis in sigmoid volvulus, while such conditions and also ileosigmoid knotting require emergency surgery. The prognosis is relatively poor under these adverse circumstances and in ileosigmoid knotting. Cite this article as: Atamanalp SS, Peksöz R, Dişçi E. Sigmoid volvulus and ileosigmoid knotting: An update. Eurasian J Med., 2022;54(Suppl. 1):S91-S96.

Sigmoid volvulus (SV) is a rare form of intestinal obstruction in which the sigmoid colon twists around its own base. Endoscopic detorsion is the primary treatment in uncomplicated patients, while urgent surgery is required in the cases with bowel perforation, peritonitis, and unsuccessful endoscopic detorsion. In surgery, the gangrenous sigmoid colon is managed by resection, whereas sigmoid detorsion alone or with an additional recurrence-reducing procedure is applied in patients with viable bowel. However, the risk of recurrence following endoscopic or operative detorsion alone is as high as 90% with a risk of mortality up to 35%. To prevent or reduce SV recurrence, some selected cases require emergent or elective recurrence-preventive management including sigmoidopexy, mesopexy, mesoplasty, extraperitonealization, sigmoidectomy, and endoscopic percutaneous sigmoidopexy. However, the indications, techniques, and results of the above-mentioned procedures are controversial. In this review, the treatment options of SV and patient selection criteria for recurrence-preventive treatments are discussed.

Objectives: Recurrence is a relatively common outcome following endoscopic decompression in sigmoid volvulus (SV). This study aims to evaluate the factors affecting recurrence in SV. Methods: In 434 patients with SV treated between June 1986 and January 2022, probable recurrence-affecting factors including age, age of SV onset, gender, dietary habit, defecation habit, altitude of living area, and SV attack count were analyzed in prospectively collected data. Results: Of 434 patients, 111 (25.6%) had recurrent SV with mean 1.6 ± 2.3 of volvulus episodes (range: 1-21 attacks). SV recurrence demonstrated a significant linear increase with age (14.3%, 17.1%, 21.5%, and 29.9%, respectively, in young, middle aged, mature, and elderly patients, p < 0.001). Recurrent SV was also significantly higher in male gender (28.5% vs 12.7%, p = 0.004), high-fiber diet habit (32.9% vs 17.7%, p < 0.001), and living at high altitude (26.9% vs 12.5%, p = 0.047). Although SV recurrence was higher in patients with chronic constipation, the difference was not significant (36.7% vs. 20.3%, p = 0.594). When compared with that of the patients with mature onset or elderly onset patients, SV attack count was significantly higher in young-onset cases (1.3±0.9 and 1.1±0.3 vs 4.6±6.9, p < 0.001).Conclusion: Elderliness, early-onset, maleness, high-fiber diet habit, high altitude, and most likely chronic constipation may be the practical clinical parameters of recurrent SV. These parameters, as well as the presence of previous SV episode history, must be considered in the decision-making process in the elective treatment of SV. doi: https://doi.org/10.12669/pjms.39.1.6882 How to cite this: Korkut E, Peksoz R, Disci E, Atamanalp SS. Factors affecting recurrence in sigmoid volvulus. Pak J Med Sci. 2023;39(1):150-153. doi: https://doi.org/10.12669/pjms.39.1.6882 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sigmoid volvulus (SV) is common in elders. For this reason, most geriatric comorbidities accompany SV. Additionally, SV may associate with a great number of physiological or pathological entities. The purpose of this review was to evaluate the kind and the incidence of such comorbidities as well as to discuss their pathophysiology. To obtain all SV-related reports in worldwide data, an electronic search of the last 57 years' literature (from 1967 to date) was made in Web of Science and PubMed databases by using “sigmoid volvulus” heading. Additionally, we evaluated our results including 1071 patients treated in a 57-year period from June 1966 to July 2023. We noted comorbid entities in each case. Tens of physiological or pathological clinical entities may accompany SV. Some entities may be the cause or result of SV, whereas some others may mimic SV or mimicked by this disease. Moreover, some factors may predispose to SV, whereas some others may initiate it. Some of these comorbidities have cause and effect relations, whereas some others are coincidental. However, the relationship between SV and some comorbid entities as well as underlying pathologies is not clear enough.