Serial Endoscopic Decompression in Recurrent Sigmoid Volvulus: Temporary Success, Definitive Failure

Abstract

Recurrent Sigmoid Volvulus (RSV) is characterized by repeated torsion of the sigmoid colon around its mesenteric axis following previous intervention, most commonly after successful endoscopic detorsion. Recurrence rates are significantly higher after non-operative management compared with definitive surgical resection. Predisposing factors include advanced age, male sex, chronic constipation, high-fiber dietary intake, and anatomical abnormalities such as a redundant sigmoid colon with an elongated mesentery. RSV is associated with substantial morbidity and carries the risk of bowel ischemia, perforation, sepsis, and death if treatment is delayed. Consequently, definitive surgical management, typically sigmoid colectomy with primary anastomosis, should be considered to minimize recurrence and prevent life- threatening complications. We report the case of a 73-year-old man with multiple recurrent episodes of sigmoid volvulus who underwent emergency sigmoid resection with primary end-to-end anastomosis after four previous hospital admissions treated with endoscopic decompression. This case illustrates the limitations of repeated endoscopic decompression as a temporizing strategy and demonstrates the potential consequences of delaying definitive management. It further emphasizes the importance of early risk stratification and timely surgical intervention in suitable patients with recurrent sigmoid volvulus.