VOLVULUS of the sigmoid colon, forming 1-4 per cent of all intestinal obstructions (Hamlin, I952), is not a sufficiently common condition in this country for any individual surgeon to reach a satisfactory conclusion on its management from his personal experience. At the same time its incidence is large enough for every surgeon to b e confronted with a number of cases in the course of his career. T h e original purpose of this paper was to suggest some tentative conclusions on its management, and to suggest particularly that the judicious use of a rectal tube might substitute elective for emergency surgery.
In the course of preparing the paper, however, the writings of Bruusgaard (1947), based on a personal experience which no British surgeon can hope to rival, were found to give authoritative support to the idea of conservative management in the acute stage of sigmoid volvulus, and this paper is now presented in the hope that the method, which is in no way new in theory, may be more widely used in practice.
CLINICAL MATERIAL
A brief account will now be given of 5 personal cases, followed by a summary of the relevant information from a total of 28 cases, 23 having been collected from hospital records. All the cases referred to were treated in the West Middlesex Hospital, the Bristol Royal Infirmary, or Weston-super-Mare General Hospital, between 1946 and 1955.
Case I.-A male of 69 years was admitted to hospital on Feb. 2, 1951, with a week's history of abdominal colic, constipation, and mucoid discharge from the rectum. During the previous two years he had had two operations for the relief of sigmoid volvulus, so that the diagnosis was not difficult to make, and an immediate Mikulicz resection of an enormous, hypertrophied sigmoid loop was performed. His progress was excellent, and, after closure of his colostomy, he was discharged on April 5. Case 2.-A man of 82 years, admitted on Dec. 28, 1951, with a similar clinical picture, of twelve days' duration. He had undergone operations for volvulus of the sigmoid colon in March, April, and October, 1951, in Canada. I n this case, also, a Mikulicz resection of a distended, hypertrophied sigmoid loop was performed, and, after closure of his colostomy, he was discharged on Jan. 27, 1952. Case 3.-A man, aged 32 years, who was admitted on Jan. 12, 1955, with 36 hours' history of severe abdominal colic and sacral backache, with absolute constipation. He had had similar attacks at intervals for two years, not requiring surgery. The diagnosis of sigmoid volvulus was confirmed by straight radiography of the abdomen, and at operation he was found to have a generalized redundancy of colon, and an enormous, twisted sigmoid loop. In view of his relative youth, the volvulus was merely untwisted, and he was discharged on Jan. 22 with arrangements made for him to return in April for resection and anastomosis of his sigmoid colon.