1. Colonoscopic Reduction of a Sigmoid Volvulus
Stuart Forman, MD, FAAFP
AAPCE Annual Meeting 2011

2. Patient Background 54 year old male from Sierra Leone
Presents with distension, obstipation, and pain
Tried to use laxatives, no success
Two prior episodes where they “put some air in the rectal area and it got better” 3 years ago

3. X-ray shows sigmoid volvulus

5. Coffee Bean Sign

6. Sigmoid vs. Cecal

7. Bird Beak sign

8. Whirlpool sign

9. Flexible Colonoscopic Reduction of Sigmoid Volvulus
First described in 1976
If successful, patient can undergo bowel prep
Have a one stage surgery instead of a 2 stage surgery
Can also determine if there is necrosis

10. Step 1: Get to the kink

11. Getting to the kink: Tips
Use plenty of water
Use as little air as possible
Be patient
Get patients on their back early
Look for necrosis

12. Step 2: Pry open the door

13. Prying opening the door: Tips
Use water if you have it—lots
Try to get around the kink by using water.
Use as little air as possible
Place patient on their back early
The kink will open only for a short time—be ready
Once it’s open, advance the scope into the volvulus
Be patient! The worst that will happen is your patient goes to surgery anyway.

15. Step 3: Suction suction suction

16. Suction suction suction tips
Suction as much air and stool as you can
Look for necrosis
Use your wash to get more stuff out
Avoid adding air
Suctioning the air should be enough to reduce the volvulus

17. Before and after reduction

18. Post procedure course
Patient began to pass stool and gas immediately after scope
Underwent bowel prep on day #2
Had uncomplicated lap-assisted sigmoid colectomy with stapled primary anastamosis on day #4
Discharged to home on day #7 eating and pooping

19. References Ghazi, Annals Surgery, March 1976
Khurana Radiology 2003; 226; 69-70
Surg. Clinics. N. America 69:6, Dec ‘89
Google images