Risk factors and surgical management of sigmoid volvulus among patients attending Al-Karama Teaching Hospital of Iraq


  • Mohammed Hillu Surriah Department of Surgery, Al-Karama Teaching Hospital, Baghdad, Iraq
  • Amine Mohammed Bakkour Department of Surgery, Al-Karama Teaching Hospital, Baghdad, Iraq
  • Nidaa Ali Abdul Hussain Department of Obstetrics and Gynaecology, Al-Yarmouk Teaching Hospital, Baghdad, Iraq




Sigmoid colon, Strangulation, Volvulus


Background: Sigmoid volvulus is defined as torsion of the sigmoid colon around its mesenteric axis, which leads to acute large intestine obstruction, which, if left untreated, often results in life-threatening complications, such as bowel ischemia, gangrene and perforation. The aim of this study was to analyse sigmoid colon volvulus when its presented as a surgical emergency.

Methods: This was a prospective study of 25 patients presented with the features of strangulated sigmoid colon volvulus to Al-Karama Teaching Hospital (surgical casualty) from March 2014 to March 2018. Eighteen patients (72%) were males and seven patients (28%) were females. The age of the patients ranged from 20-70 years. The main risk factor was chronic constipation, laxative dependency and high fiber diet. The main presenting symptoms and signs were absolute constipation, generalized abdominal distension, tenderness, tachycardia and fever. The patients were investigated by plain abdominal X-ray and haematological investigations.

Results: Among the 25 patients, 13 had distended gangrenous sigmoid colon volvulus, 9 out of the remaining 12 patients were discovered to have distended non-gangrenous sigmoid colon volvulus of the rest 3 patients, 2 were found to have Ileo-sigmoid knotting and the last patient had a perforated gangrenous sigmoid colon volvulus. Four patients developed postoperative complications and one patient died.

Conclusions: Volvulus of the sigmoid colon is more predominant in males. Middle age individuals seem to be the most affected group by sigmoid colon volvulus. Majority of patients with sigmoid colon volvulus have history of chronic constipation, laxative dependency and high fiber diet.


Katsikogiannis N, Machairiotis N, Zarogoulidis P, Sarika E, Stylianaki A, Zisoglou M, et al. Management of sigmoid volvulus avoiding sigmoid resection. Case Rep Gastroenterol. 2012;6(2):293-9.

Raveenthiran V. Observations on the pattern of vomiting and morbidity in patients with acute sigmoid volvulus. J Postgraduate Med. 2004;50(1):27.

Konder IJ, Fry RD, Fleshman JW. Colon, sigmoid volvulus. In: Schwartz SI, Fischer JE, Daly JM, Galloway AC, Shires GT, Spencer FC, eds. Scharwtz, Principle of Surgery. 7th ed. USA: Mc-Graw-Hill; 1999: 1265-1276.

Sule AZ, Misauno M, Opaluwa AS, Ojo E, Obekpa PO. One stage procedure in the management of acute sigmoid volvulus without colonic lavage. Surg. 2007;5(5):268-70.

Suleyman O, Kessaf AA, Ayhan KM. Sigmoid volvulus: long-term clinical outcome and review of the literature. South Afr J Surg. 2012;50(1):9-15.

Coban S, Yilmaz M, Terzi A, Yildiz F, Ozgor D, Ara C, et al. Resection and primary anastomosis with or without modified blow-hole colostomy for sigmoid volvulus. World J Gastroenterol: WJG. 2008;14(36):5590.

Gupta SS, Singh O, Paramhans D, Mathur RK. Tube sigmoidostomy: a valuable alternative to sigmoidopexy for sigmoid volvulus. J Visceral Surg. 2011;148(2):e129-33.

Madiba TE, Thomson SR. The management of sigmoid volvulus. J Royal Coll Surg Edinburgh. 2000;45(2).

Turan M, Sen M, Karadayi K, Koyuncu A, Topcu O, Yildirir C, et al. Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process. Rev Español Enfermedades Diges. 2004;96(1):32-5.

Martínez DA, Yáñez JL, Souto JR, Vázquez MM, González BC, Suárez FL, et al. Indication and results of endoscopic management of sigmoid volvulus. Rev Espanol Enfermedades Diges: Org Off Soc Espanol Patol Diges. 2003;95(8):544-8.

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia: WB-Saunders; 2003: 1369-1364.

Mann CV. Intestinal obstruction, volvulus. In: Mann CV, Russell RCG, Williams NS, eds. Bailey and Love’s Short Practice of Surgery. 22nd ed. London; Chapman-Hall; 1995: 820-821.

Bortolo D.C, Johnston JM, Macleod IB, Rintoul RF. Operations on the intestine: volvulus of the colon. In: Rintoul RF, eds. Farquharson’s Textbook of Operative Surgery. 8th ed. UK; Churchill-livingstone: 1995.

Schrock TR. Large intestine volvulus. In: Way LW, eds. Current surgical diagnosis and treatment. 8th ed. USA, Prentice; Hall-International-Appleton-Lange; 1988: 614-616.

Nivatvongs S. Volvulus of the colon. In: Gordon PhH, Nivatvongs S, eds. Principles and Practice of Surgery for the Colon, Rectum and Anus. 3rd ed. USA, Informa-Healthcare; 2008: 971-978.

Anthony L. Imbembo, Karrl A Zucker. Volvulus of the colon. In: Sabiston DC, eds. Sabiston Textbook of Surgery. The biological basis of modern surgical practice. 15th ed. USA, WB-Saunders; 1997: 1015-1020.

Armstrong DN, Ballntyne G.H. Colonic surgery for acute condition: volvulus of the colon. In: Dudely H, Karter D, Russell RC, Pitt HA. Atlas of General Surgery. 3rd ed. London, Chapman-Hall; 1996: 750-765.

Catalano O. Computed tomographic appearance of sigmoid volvulus. Abdominal imaging. 1996;21(4):314-7.

Charles BF, Jaffe BM. Colon, sigmoid volvulus. In: Schwartz’s Principles of Surgery. 10th ed. New York, McGraw-Hill; 2015: 1219-1221.

Mellor SG, Phillips RK. The aetiology and management of sigmoid volvulus in the UK: how much colon need be excised?. Ann R Coll Surg Engl. 1990;72(3):193-5.

Rennie JA. Peptic ulceration and sigmoid volvulus in India. Ann Royal Coll Surg Eng. 1981;63(2):105.

Bhatnagar BN, Sharma CL. Non-resective alternative for the cure of non-gangrenous sigmoid volvulus. Dis Colon Rectum. 1998;41(3):381-8.

Raveenthiran V, Madiba T, Atamanalp S, De U. Volvulus of the sigmoid colon. Colorectal Disease. 2010;12(7Online):e1-e17.

Baker DM, Wardrop PJ, Burrell H, Hardcastle JD. The management of acute sigmoid volvulus in Nottingham. J Royal Coll Surg Edinburgh. 1994;39(5):304-6.

Taha SE, Suleiman SI. Volvulus of the sigmoid colon in the Gezira. Brit J Surg. 1980;67(6):433-5.

Rosenthal MJ, Marshall CE. Sigmoid volvulus in association with parkinsonism report of four cases. J Am Geriatrics Soc. 1987;35(7):683-4.

Robert J.C. Steele. Volvulus of the sigmoid colon. In: Cuschieri A, Steele R, Moossa AR, eds. Essential Surgical Practice. 4th ed. UK, Arnold; 2002: 614-616.

Winslet MC. Intestinal obstruction, volvulus. In: Russell RCG, Williams NS, Bulstrode CJK, eds. Bailey and Love’s Short practice of Surgery. 23rd ed. London, Arnold; 2000: 1069-1070.

Friedman JD, Odland MD, Bubrick MP. Experience with colonic volvulus. Dis Colon Rectum. 1989;32(5):409-16.

Mokoena TR, Madiba TE. Sigmoid volvulus among Africans in Durban. Tropical Geograph Med. 1995;47(5):216-7.

Bagarani M, Conde AS, Longo R, Italiano A, Terenzi A, Venuto G. Sigmoid volvulus in West Africa: a prospective study on surgical treatments. Dis Colon Rectum. 1993;36(2):186-90.

Osime U. Volvulus of the sigmoid colon. J Royal Coll Surg Edinburgh. 1980;25(1):32-7.






Original Research Articles