Colonic Conditions: Volvulus

Abstract

Colonic volvulus accounts for the third most common cause of large bowel obstruction in North America, and typically involves the sigmoid or cecum. The diagnosis can be suspected clinically, but is usually confirmed radiologically with a CT scan. The management begins as with any other cause of bowel obstruction, and includes fluid resuscitation, nasogastric decompression, and risk stratification. In the case of sigmoid volvulus, if there are no signs of colonic ischemia or perforation, endoscopic detorsion should be attempted and is usually successful. This key intervention can convert an emergency operation into a more elective one. Given the high recurrence rate, particularly in the first few months following the index episode, sigmoid colectomy should be performed in all operative candidates and ideally on the index admission. The decision to perform an anastomosis is at the discretion of the surgeon, and depends on the patient’s clinical status. Non-resective operative interventions for sigmoid volvulus have been described, but are less effective in preventing future episodes and carry similar postoperative morbidity. In the case of cecal volvulus, all patients are managed operatively as soon as the diagnosis is made. While segmental colectomy is most commonly performed, cecopexy is a valid alternative when dealing with healthy bowel.