Update on the Management of Acute Sigmoid Volvulus: Endoscopic Decompression and Definitive Surgical Treatment

Sigmoid volvulus (SV) is a form of mechanical bowel obstruction with a likely multifactorial etiology.It occurs far more frequently in the so-called "volvulus belt" countries than in Western nations.In Western countries, its relatively low incidence has led to a lack of management experience.Establishing a diagnosis can be difficult and challenging, while the timing of presentation is a crucial determinant of prognosis.Delayed admission may result in bowel ischemia and gangrene.These complications are associated with increased morbidity and high mortality.Many aspects of SV management remain debatable, and proposed treatment algorithms are not universally accepted.In most cases of acute, uncomplicated SV, endoscopic decompression is the first-line treatment.However, this approach is commonly associated with SV recurrence if it is not followed by surgery.For complicated SV cases, emergent resection surgery can provide an effective and definitive treatment.Elderly patients and those with severe comorbidities may require careful preoperative assessment and optimization.Definitive surgery under general anesthesia is often postponed in this high-risk population.This review aims to examine the diagnostic challenges associated with acute SV and to evaluate the safety and effectiveness of currently available therapies.Further clinical research is needed to clarify the most appropriate treatment strategies for SV.