Sigmoid volvulus is the third leading cause of colonic obstruction in adults. Surgical
resection with primary anastomosis is the standard of care [1]. Endoscopic reduction is a feasible option in patients with uncomplicated conditions
[2] despite the fact that mechanical detorsion is not always successful, even by skilled
hands. Few data are available concerning the role of self-expanding metallic stents
(SEMS) in the treatment of benign colorectal strictures, including sigmoid volvulus.
An 82-year-old man was admitted because of intestinal occlusion. Full blood count
and chemistry were normal but the computed tomography (CT) scan showed a sigmoid volvulus
([Fig. 1 a]). Following consultation with the surgeon, an attempt was made to reduce the volvulus
endoscopically in order to schedule elective surgery. Unfortunately, the attempt at
detorsion failed, so instead a Niti-S enteral uncovered stent (D-Type; TaeWoong, Seoul,
Korea) was placed, as shown in [Fig. 1 b]. The patient’s symptoms improved rapidly, and 48 hours later he underwent resection
of the volvulus. The patient was discharged in a good clinical condition after 7 days.
Fig. 1 Computed tomography scan of 82-year-old patient with intestinal occlusion. a Scan shows the sigmoid volvulus (red arrow). b Phases of the placement of a self-expanding metallic stent.
Nonresective alternatives have been used in sigmoid volvulus but with mixed results,
and there are no large randomized controlled trials comparing stent placement with
colonic resection [1]. It is widely accepted that SEMS placement for benign colonic obstruction due to
diverticular stricture is not useful (high complication rates [3]
[4]), and very few data are available on the bridge-to-surgery efficacy of SEMS in treating
twisted colon. The new Niti-S enteral uncovered stent (D-Type) is made of nitinol
wire, which provides a flexible, fine mesh tubular prosthesis with eight radiopaque
markers for an accurate release. Our experience suggests that this type of stent may
be an effective and safe bridge option in patients with uncomplicated conditions who
have sigmoid volvulus. This is because of the D-Type’s conformability, which facilitates
immediate, continuous wall apposition, and which in turn decompresses the colon until
mandatory resective surgery can be performed.
Endoscopy_UCTN_Code_TTT_1AQ_2AF
