Percutaneous endoscopic sigmoidopexy for sigmoid volvulus: A case report

Abstract

Introduction: Sigmoid volvulus often recurs and it is controversial whether preventive surgery should be performed in recurrent cases, especially in elderly and high-risk cases. Herein, we report a case of successful endoscopic sigmoidopexy using fixation to the abdominal wall.

Case presentation: The patient was an 86-year-old woman with multiple system atrophy, cerebral infarction, and disuse syndrome. She was admitted to our hospital with a recurrent sigmoid volvulus. Since surgery was considered high-risk, percutaneous endoscopic sigmoidopexy with fixation to the abdominal wall was indicated.

Discussion: Percutaneous endoscopic sigmoidopexy was performed for this high-risk case with recurrent sigmoid volvulus. This procedure is advantageous in that suture removal is not necessary because the fixation sutures are buried subcutaneously. Reviewing the relevant literature, we believe that this is the first case of percutaneous endoscopic sigmoidopexy using abdominal wall fixation with buried sutures.

Conclusion: Although further experience is necessary, percutaneous endoscopic sigmoidopexy may be an acceptable treatment for recurrent sigmoid volvulus in high-risk patients.

Keywords: Percutaneous endoscopic colostomy; Percutaneous endoscopic sigmoidopexy; Sigmoid volvulus.

Fig. 1

An abdominal X-ray shows the coffee bean sign. The diagnosis is sigmoid volvulus.

Fig. 2

The sigmoid volvulus has been repositioned under radiographic contrast enema, the optimum points of the sigmoidopexy determined, and metal markers placed at these points.

Fig. 3

Sigmoidopexy has been performed with the Ideal PEG kit (Olympus Medical Systems, Tokyo, Japan) under colonoscopy. The fixation knots are buried subcutaneously.

Fig. 4

CT scan shows the sigmoid colon fixed to the abdominal wall after the sigmoidopexy.