AbstractFifty patients presenting with acute volvulus of the sigmoid colon have been analyzed. The diagnosis was made in 39 patients from the presenting features and abdominal radiographs. Deflation by sigmoidoscopy and flatus tube was performed in 19 patients with initial success in 15. Recurrent volvulus occurred in 6 of these patients. Laparotomy was carried out in 36 patients and colonie gangrene was present in 6 patients. The operative mortality rate was 42%. Mortality was related to a combination of age, intercurrent medical illness, and sepsis. Simple operative reduction was associated with a lower mortality when compared to resection but had a higher incidence of recurrent volvulus. This study supports the use of sigmoidoscopic reduction as the primary treatment of acute sigmoid volvulus. Laparotomy and colonic resection should be reserved for those patients who are medically fit and should ideally be performed on an elective basis after preliminary decompression. In unfit patients in whom sigmoidoscopic reduction fails, detorsion and colopexy is advocated.