The procedure varies depending on the volvulus location, severity, and patient stability:

1. Before Procedure Evaluation:
   
   • Diagnosis:
     
     • Physical exam reveals abdominal distension, tenderness, and absent bowel sounds.
     • X-ray or CT scan confirms volvulus with a “coffee bean” sign (sigmoid volvulus) or “whirlpool” sign (cecal/midgut volvulus).
     • Blood tests assess for dehydration, electrolyte imbalances, and signs of ischemia (e.g., elevated lactate).
   • IV fluids and nasogastric tube decompression stabilize the patient.
   • Patients with signs of perforation or peritonitis (fever, severe tenderness) require immediate surgery, skipping endoscopic detorsion.
2. Detorsion Techniques:
   
   • Endoscopic Detorsion (Sigmoid Volvulus):
     
     • Performed under sedation or light anesthesia, lasting 30–60 minutes.
     • A flexible sigmoidoscope is inserted through the anus to visualize the twisted sigmoid colon.
     • The scope gently untwists the volvulus, often confirmed by a rush of gas and stool.
     • A rectal tube is placed to maintain decompression and prevent immediate recurrence, left in for 24–48 hours.
     • Suitable for stable patients without signs of bowel ischemia or perforation.
     • Success rate: 70–90%, but recurrence risk is high (40–70%) without definitive surgery.
   • Surgical Detorsion:
     
     • Performed under general anesthesia, lasting 1–2 hours, often in unstable patients or failed endoscopic attempts.
     • Open Surgery:
       
       • A midline abdominal incision provides access to the twisted bowel.
       • The surgeon manually untwists the volvulus and assesses bowel viability (color, peristalsis).
       • If the bowel is viable, detorsion alone may suffice; if non-viable, resection (e.g., sigmoidectomy) is performed.
     • Laparoscopic Surgery:
       
       • Uses 3–4 small incisions, a laparoscope, and instruments to untwist the bowel.
       • Preferred in stable patients, offering faster recovery.
     • A temporary colostomy may be created if resection is needed in an emergency (e.g., Hartmann’s procedure).
   • Definitive Surgery Post-Detorsion:
     
     • Sigmoid volvulus: Elective sigmoidectomy within 48–72 hours to prevent recurrence.
     • Cecal volvulus: Right hemicolectomy or cecopexy (fixation of the cecum to the abdominal wall).
     • Midgut volvulus: Ladd’s procedure (correcting malrotation and fixing the bowel).
3. After Procedure:
   
   • Patients are monitored in the hospital for 2–5 days (endoscopic) or 5–10 days (surgical).
   • IV fluids and antibiotics manage dehydration and infection risk.
   • Bowel function resumes within 2–4 days, starting with clear liquids.
   • Follow-up plans definitive surgery to prevent recurrence.