Background: Management of acute sigmoid volvulus was documented using a variety of surgical techniques. It has been established that mechanical bowel preparation is not required for elective colorectal surgery. To lower the risk of post-operative infectious complications and anastomotic dehiscence, one-stage primary resection and anastomosis of left sided colon blockage with on-table antegrade colonic lavage are becoming more and more popular. Objective: The aim of the current study was to assess the safety of single stage resection and anastomosis in the treatment of acute left sided colonic blockage brought on by acute sigmoid volvulus without intraoperative colonic lavage. Patients and methods: This study was conducted in the Department of Surgery, Ain shams University Hospitals (Cairo, Egypt) between June 2018 till June 2021. It included 37 patients who presented with acute sigmoid volvulus and managed by colonic resection and primary anastomosis then furtherly classified into two groups based on the usage of antegrade colonic lavage to evaluate their outcome. Results: Preoperative characteristics of the 2 studied groups were comparable. In terms of mortality, general morbidity, or significant morbidity, there was no difference between the 2 studied groups. Operative time was significantly higher in Group I where Intra-operative Antegrade Colonic lavage (IOACL) took place, which could be attributed to the extra step of setting the lavage system and colonic irrigation time. Of the studied 37 patients, superficial wound infection occurred in 12 patients and 3 of them progressed to develop complete wound dehiscence, however; neither required further surgery as no disruption and managed conservatively with antibiotics and wound dressing. Conclusion: Colonic resection and primary anastomosis can be used to safely treat left-sided colonic blockage brought on by acute sigmoid volvulus without the need for mechanical bowel preparation.