Management and outcomes of sigmoid volvulus: a retrospective cohort study of 46 patients at a tertiary care center.

Introduction: Sigmoid volvulus (SV) is a potentially life-threatening cause of large bowel obstruction that requires prompt diagnosis and intervention to reduce the morbidity and mortality rates. This study evaluated the clinical characteristics and outcomes of patients presenting with SV at a tertiary care center. Presentation of case: We retrospectively reviewed the records of all patients who presented with SV between October 2020 and September 2025. Demographic data, comorbidities, imaging, endoscopic decompression, surgical intervention, length of hospital stay, postoperative complications, and 30- and 100-day mortality were also recorded. Discussion: Forty-six patients were identified (29 men and 17 women; mean age, 77.67 years). All patients underwent initial imaging with abdominal radiography or CT, followed by flexible sigmoidoscopy for decompression. Eighteen patients underwent surgical management, whereas 28 were managed conservatively. The operative group had a longer mean hospital stay (29.18 ± 26.02 days SD) than the non-operative group (12.66 ± 16.52 days SD). Postoperative complications occurred in 28% of the surgically treated patients. No 30-day deaths occurred in the operative group, although two 100-day deaths were recorded in the same group. In comparison, the nonoperative group had nine 30-day deaths and five 100-day deaths, largely among patients with high ASA scores, comorbidities, frailty, and neurological impairment. Conclusion: SV predominantly affected elderly patients with comorbidities in this cohort. Although surgery was associated with longer hospitalization, it demonstrated lower short-term mortality than conservative management. Early clinical stratification and timely definitive intervention may improve outcomes but must be balanced against the risks associated with operating on frail geriatric patients.