What is the initial treatment for volvulus if endoscopic decompression fails?

The initial treatment for volvulus, particularly if endoscopic decompression has failed, is surgical correction. Volvulus occurs when a loop of the intestine twists around itself and the mesenteric vessels, potentially leading to ischemia and bowel necrosis if not addressed promptly.

In cases where endoscopic decompression, which may help relieve the obstruction and restore normal bowel function, does not succeed, surgery becomes imperative. Surgical intervention typically involves untwisting the volvulus and may also require resecting any necrotic bowel segments if they are identified during the procedure.

Medical management alone is insufficient in this scenario, as it does not address the underlying mechanical obstruction. Radiation therapy is not a treatment modality utilized for volvulus and is reserved for other conditions, such as malignancies. Observation may be suitable for certain non-emergent conditions but is inappropriate when there is a risk of bowel ischemia or perforation due to volvulus. Therefore, surgical correction is the necessary step when less invasive measures have failed.