Volvulus of the sigmoid colon.

A 30-year experience with sigmoid volvulus from the City of Memphis Hospital is presented with 121 cases. Differentiating viable from gangrenous sigmoid volvulus is difficult from history, physical examination, or laboratory data and one must rely on sigmoidoscopy. Sigmoidoscopy with insertion of a colon tube is the initial management with operative detorsion only if sigmoidoscopy fails. Elective sigmoid resection is advocated in view of the high recurrence rate. In gangrenous sigmoid volvulus, a Hartmann's procedure is preferred. There is a significant rate of "recurrent sigmoid volvulus" after elective resection.