Document Overview

Design and created by Guideline Central in participation with the American Society of Colon and Rectal Surgeons.

Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction

American Society of Colon and Rectal Surgeons

Publication Date: Aug 31, 2021

Page Last Updated: May 5, 2026

The GRADE system: grading recommendations

Grade	Description	Benefit vs. risk and burdens	Quality of supporting evidence	Implications
1A	Strong recommendation, High-quality evidence	Benefits clearly outweigh risk and burdens or vice versa	RCTs without important limitations or overwhelming evidence from observational studies	Strong recommendation, can apply to most patients in most circumstances without reservation
1B	Strong recommendation, Moderate-quality evidence	Benefits clearly outweigh risk and burdens or vice versa	RCTs with important limitations (inconsistent results, methodologic flaws, indirect or imprecise) or exceptionally strong evidence from observational studies	Strong recommendation, can apply to most patients in most circumstances without reservation
1C	Strong recommendation, Low- or very-low quality evidence	Benefits clearly outweigh risk and burdens or vice versa	Observational studies or case series	Strong recommendation but may change when higherquality evidence becomes available
2A	Weak recommendation, High-quality evidence	Benefits closely balanced with risks and burdens	RCTs without important limitations or overwhelming evidence from observational studies	Weak recommendation, best action may differ depending on circumstances or patients’ or societal values
2B	Weak recommendations, Moderate-quality evidence	Benefits closely balanced with risks and burdens	RCTs with important limitations (inconsistent results, methodologic flaws, indirect or imprecise) or exceptionally strong evidence from observational studies	Weak recommendation, best action may differ depending on circumstances or patients’ or societal values
2C	Weak recommendation, Low- or very-low quality evidence	Uncertainty in the estimates of benefits, risks and burden; benefits, risk, and burden may be closely balanced	Observational studies or case series	Very weak recommendations; other alternatives may be equally reasonable

Document Overview

Document Title: Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction

Authoring Society: American Society of Colon and Rectal Surgeons

Document Publication Date: Aug 31, 2021

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: journals.lww.com/dcrjournal/Fulltext/2021/09000/The_American_Society_of_Colon_and_Rectal_Surgeons.5.aspx

Source Citation: Alavi K, Poylin V, Davids JS, Patel SV, Felder S, Valente MA, Paquette IM, Feingold DL; Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction. Dis Colon Rectum. 2021 Sep 1;64(9):1046-1057. doi: 10.1097/DCR.0000000000002159. PMID: 34016826.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Scope: Management, Prevention

Diseases/Conditions (MeSH)

D003112 - Colonic Pseudo-Obstruction

Keywords: Acute Pseudo-Obstruction, Clinical Practice Guideline, Colonic volvulus, Large-bowel obstruction, anus, cecal volvulus, colon, rectum, sigmoid volvulus

Inclusion Criteria: Female, Male, Adult

Health Care Settings: Ambulatory, Hospital

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 126

Literature Search Start Date: Tuesday, December 31, 2013

Literature Search End Date: Monday, January 18, 2021

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: No

Discloses conflicts of interest?: No

Includes benefits/harms analysis with recommendations?: Yes