# An Unexpected Twist: Sigmoid Volvulus Complicated by Peritoneal Metastases

## TL;DR

A rare case of sigmoid volvulus complicated by peritoneal metastases required surgery due to failure of endoscopic treatment.

## Contribution

Highlights the management challenges of sigmoid volvulus in cancer patients with peritoneal metastases.

## Key findings

- Recurrent sigmoid volvulus was unresponsive to endoscopic detorsion due to peritoneal metastases.
- Surgical resection was necessary to resolve the torsion caused by metastatic tethers.
- Collaborative care is essential for managing sigmoid volvulus in patients with malignancy.

## Abstract

Sigmoid volvulus is the mechanical torsion of the sigmoid colon, its mesentery, and blood supply around itself, resulting in luminal obstruction and colonic ischemia. Initial management typically involves endoscopic detorsion; however, patients with peritonitis or who fail endoscopic therapy warrant surgical intervention. This case illustrates the rare presentation of recurrent sigmoid volvulus, which was refractory to endoscopic detorsion due to complications of peritoneal metastases, which tethered the sigmoid into a torsed position, ultimately requiring surgical resection. This report emphasizes the need for tailored, collaborative approaches to managing sigmoid volvulus in patients with underlying malignancy.