What Is Sigmoid Volvulus? Symptoms, Causes, and Treatment

Medically Reviewed By Kelsey Trull, PA-C
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Sigmoid volvulus is when the sigmoid part of the colon twists around itself and enlarges. It causes bowel obstruction, preventing gas and stool from passing through. Volvulus is a painful, life threatening condition that may involve emergency surgery and removal of the sigmoid colon.

Sigmoid volvulus is the most common type of intestinal volvulus. It can occur in children, but it is more likely in adults.

Read on to learn about sigmoid volvulus causes, risk factors, and symptoms. This article will also describe the treatment options and answer questions that people often ask about sigmoid volvulus.

Sigmoid volvulus explained       

Illustration of a normal large intestine (large bowel) next to a large intestine with a sigmoid volvulus
Illustration of a normal large intestine (large bowel) next to a large intestine with a sigmoid volvulus. Illustration by Mekhi Baldwin.

The sigmoid colon is an S-shaped portion of the large intestine located at the end of the digestive tract. It is the last part of the colon before the rectum. Usually, the mesentery holds the intestines in place. It involves a series of folds of the inner lining of the abdominal wall.

Changes in the structure of the sigmoid colon or mesentery can cause sigmoid volvulus. For example, the colon and attachments may weaken and stretch out with age. This frees up the expanded colon to loop out and twist, forming a volvulus.

Volvulus obstructs the bowel, trapping gas and stool inside. Volvulus can also reduce blood flow to the area. A lack of adequate blood supply can damage the colon.

Volvulus is a serious condition that often requires emergency surgery to resolve and help prevent complications.

What causes sigmoid volvulus?

Sigmoid volvulus is more likely to occur in adults, especially adults between 50 and 80 years old, says the National Institute of Diabetes and Digestive and Kidney Diseases. It is rare in children.

In adults

Sigmoid volvulus tends to be more likely in older adults, who:

  • live with chronic constipation
  • take laxatives frequently
  • consume too much fiber
  • experience a chronic medical condition, especially nervous system problems
  • have abdominal adhesions from prior abdominal surgery
  • reside in a long-term care facility

Structural differences that increase the chance of sigmoid volvulus include:

  • a longer colon than usual
  • megacolon, a wider than usual colon due to genetic or acquired factors
  • mesentery attachment anomalies, which allow the colon to move more than it should

In children

Causes of pediatric sigmoid volvulus include:

  • a longer colon than usual
  • mesentery attachment anomalies
  • Hirschsprung’s disease, a genetic condition that causes constipation and bowel obstruction
  • Chagas’ disease, a parasitic infection that can affect the bowel

What are the key symptoms of sigmoid volvulus?

Symptoms of sigmoid volvulus include:

  • lower abdominal pain, which may be severe and relieved by passage of stool or gas
  • abdominal distension
  • bloating
  • constipation
  • tender abdomen, by touch
  • nausea with or without vomiting

People with sigmoid volvulus may experience symptoms for several days.

A 2019 research review of pediatric sigmoid volvulus points out that children may have a history of unexplained constipation and abdominal distention that comes and goes.

Additionally, symptoms of sigmoid volvulus may be due to its complications. These include:

When to contact a doctor

Contact a doctor for symptoms of volvulus, infection, or severe pain, even if the pain comes and goes.

Call 911 for symptoms of shock.

How do doctors diagnose sigmoid volvulus?

Your doctor will confirm the diagnosis of sigmoid volvulus through:

How do doctors treat sigmoid volvulus?

Experts consider sigmoid volvulus a medical emergency that requires prompt treatment. The specific treatment plan may depend on whether the diagnosis is early or late. The two main procedures are:

  • Flexible sigmoidoscopy: A type of colonoscopy that examines the inside of the sigmoid colon. The doctor passes a lighted, flexible tube up the rectum to the sigmoid.
  • Partial colectomy: Also known as a bowel resection, it is the surgical removal of part of the colon. This surgery is either an open or minimally invasive procedure. Learn more about colectomy here.

Early diagnosis

If volvulus does not damage the colon, your doctor may perform flexible sigmoidoscopy. By gently passing the flexible colonoscope up the rectum to the volvulus, they may be able to unravel it. However, this is a temporary solution because it will likely form again.

If the sigmoidoscopy is effective but another volvulus is likely, your doctor may recommend partial colectomy. Your doctor will help you decide on the treatment plan that is safe for you.

You may or may not need a colostomy. This is when the end of the resected colon connects to a new hole in the abdominal wall. Your stool collects in a pouch outside your body. Whether or not you need a colostomy may depend on how much colon the surgeon needs to remove, your overall health and surgical history, and other factors.

Late diagnosis and complications

If there are complications, such as perforation or reduced blood flow to the area, known as ischemia, you will need an emergency partial colectomy. During emergency surgery, the chance of colostomy is higher.

Read about what to expect after a colectomy here.

In addition to surgery, you will have IV fluids and possibly antibiotics to treat or prevent dehydration and infection, respectively.

What is the outlook?

Early diagnosis and treatment for sigmoid volvulus has a greater chance of a positive outcome. A 2020 study concluded that emergency surgery for sigmoid volvulus led to more complications than elective surgery.

The study specifically noted that flexible sigmoidoscopy followed by minimally invasive partial colectomy may be the “optimal clinical option.” Minimally invasive means the surgeon makes small incisions in the abdomen and inserts surgical instruments through them. They perform the surgery as they view the surgical area on a computer screen.

Open surgery is more likely with emergency surgery, according to the study. Open surgery involves a larger incision.

Learn more about colectomy surgical approaches here.

Other frequently asked questions

Kelsey Trull, PA-C, reviewed the following questions.

Is a sigmoid volvulus life threatening?

Sigmoid volvulus is a serious condition that requires prompt attention. Any delay in treatment may lead to life threatening complications.

Can you feel sigmoid volvulus happening?

If you have sigmoid volvulus, you will feel:

Summary

Sigmoid volvulus is a gastrointestinal condition and medical emergency. It occurs when the sigmoid colon becomes twisted and traps stool inside it. Volvulus can be quite painful. It can also reduce the blood supply to the bowel tissues, which can cause permanent damage.

Surgery to unravel the sigmoid colon is the main treatment. Removal of that part of the colon may also be necessary.

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Medical Reviewer: Kelsey Trull, PA-C
Last Review Date: 2022 Aug 17
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Anatomic problems of the lower GI tract. (n.d.). https://www.niddk.nih.gov/health-information/digestive-diseases/anatomic-problems-lower-gi-tract
  2. Baiu, I., et al. (2019). Sigmoid volvulus. https://www.jamanetwork.com/journals/jama/fullarticle/2736565
  3. Birth Defects Surveillance Toolkit. (2022). https://www.cdc.gov/ncbddd/birthdefects/surveillancemanual/index.html
  4. Gohsman, Z., et al. (2021). Endoscopic reduction of sigmoid volvulus in a 15-year-old male. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330459/
  5. Hirschsprung disease. (n.d.). https://www.niddk.nih.gov/health-information/digestive-diseases/hirschsprung-disease
  6. Lee, B., et al. (2019). Pediatric sigmoid volvulus [Abstract]. https://pubmed.ncbi.nlm.nih.gov/29596283/
  7. Lee, K., et al. (2020) Surgical management of sigmoid volvulus: A multicenter observational study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837394/
  8. Lieske, B. (2022). Sigmoid volvulus. https://www.ncbi.nlm.nih.gov/books/NBK441925/
  9. Parolini, F., et al. (2016) Endoscopic management of sigmoid volvulus in children. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919692/
  10. Wang, X. J., et al. (2020). Chronic megacolon presenting in adolescents or adults: Clinical manifestations, diagnosis and genetic associations. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6744965/