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Sigmoid Volvulus Management Algorithm (ASCRS)

Sigmoid Volvulus Management Algorithm (ASCRS): Sigmoid Volvulus (X-ray/CT) → Peritonitis or Gangrene? → Emergency Laparotomy.

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. ▶
    Start

    Sigmoid Volvulus (X-ray/CT)

    Coffee bean sign, whirl sign on CT

    1. ◆
      Decision

      Peritonitis or Gangrene?

      1. ■
        End

        Emergency Laparotomy

        Hartmann's or primary anastomosis ± diversion

      2. ●
        Action

        Endoscopic Decompression

        Rigid/flexible sigmoidoscopy + rectal tube

        1. ◆
          Decision

          Decompression Successful?

          1. ●
            Action

            Elective Sigmoid Resection

            Same admission or within 2-4 weeks

            1. ■
              End

              Sigmoid Colectomy

              Primary anastomosis if stable, healthy bowel

          2. ●
            Action

            Failed Decompression

            Proceed to surgery

Guideline Source

ASCRS Clinical Practice Guidelines: Colonic Volvulus

DOI: 10.1097/DCR.0000000000001430View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Recurrence after decompression is high
  • Definitive surgery recommended if fit
  • Gangrenous bowel requires emergency surgery

Applicable Regions

USAUUKEU

US: ASCRS guidelines

Africa/Asia: Higher incidence, often younger patients

Version 1Next review: 2028-01-01

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Frequently Asked Questions

What is the Sigmoid Volvulus Management Algorithm (ASCRS)?

The Sigmoid Volvulus Management Algorithm (ASCRS) is a management clinical algorithm for Colorectal Surgery. It provides a structured decision tree to guide clinical decision-making, based on ASCRS Clinical Practice Guidelines: Colonic Volvulus.

What guideline is the Sigmoid Volvulus Management Algorithm (ASCRS) based on?

This algorithm is based on ASCRS Clinical Practice Guidelines: Colonic Volvulus (DOI: 10.1097/DCR.0000000000001430).

What are the limitations of the Sigmoid Volvulus Management Algorithm (ASCRS)?

Known limitations include: Recurrence after decompression is high; Definitive surgery recommended if fit; Gangrenous bowel requires emergency surgery. Individual patient factors may require deviation from these recommendations.

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