Approach to the management of sigmoid volvulus in adults

* Patients with perforation or peritonitis generally should not have their volvulus detorsed to avoid reperfusion injury. Instead, they should undergo resection of the compromised bowel in its volvulized position.
¶ The choice of reconstruction must be individualized based on the patient's clinical parameters. Hartmann's procedure is preferred in the presence of hemodynamic instability, coagulopathy, acidosis, or hypothermia.