Endoscopic detorsion for sigmoid volvulus using unsedated water-immersion colonoscopy

We report a simple method of endoscopic detorsion for sigmoid volvulus using unsedated water-immersion colonoscopy, which we currently use in the majority of our cases.

Importantly, volvulus detorsion with a colonoscope should be attempted only in patients with an absence of necrotic findings. Endoscopic detorsion is performed without fluoroscopic guidance. A cap or hood attached to the tip of the colonoscope, which maintains a distance between the instrument and the colonic wall, so keeping the luminal direction in view, is used to aid insertion [1]. The water-immersion method involves water infusion in lieu of air insufflation as the principal modality to decrease pain during insertion of the colonoscope [2] [3] [4]. Water is infused into the rectum through the biopsy port of the scope using two 50-mL disposable syringes or intermittently infused using a water-jet system. Removal of residual luminal air diminishes the boundary and improves the view. Water accumulates around the tip of the colonoscope and collapses the colon as previously described [2] [4].

The colonoscope is inserted with a twisting motion, according to the torsion of the sigmoid colon, and is typically passed under direct observation through the normal-caliber colon to the point of obstruction. This point classically appears as a termination of the lumen in a “whirl sign” [5]. Care needs to be taken to avoid air insufflation while gently attempting to pass the scope through the twisted segment ([Fig. 1 a]). If this process is successful, the distended proximal segment ([Fig. 1 b]) is decompressed using endoscopic suction, which often results in spontaneous detorsion. When liquid or soft stools flow out, the success of endoscopic detorsion is confirmed.

Fig. 1 Endoscopic appearances of a sigmoid volvulus showing: a the mucosa at the point of twisting; b the dilated lumen in the twisted segment of sigmoid colon.

In our experience the success rate of this treatment has been 100 %, therefore we believe an endoscopic detorsion is a reasonable treatment for elderly patients with sigmoid volvulus.

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Competing interests: None

• References

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