Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction

Initial evaluation should include a focused history, physical examination, and basic laboratory assessment.

In hemodynamically stable patients, colonic volvulus is often initially evaluated with plain abdominal radiographs, whereas CT imaging may be used to confirm the diagnosis.

Patients without hemodynamic instability, peritonitis, or evidence of perforation should typically undergo lower endoscopy to assess sigmoid colon viability, detorse the anatomy, and decompress the colon.

Urgent sigmoid resection is indicated when endoscopic detorsion of the sigmoid colon fails and in cases of nonviable or perforated colon.

Urgent sigmoid resection is indicated when endoscopic detorsion of the sigmoid colon fails and in cases of nonviable or perforated colon.

Operations without resection including detorsion alone, sigmoidopexy, and mesosigmoidoplasty are inferior to sigmoid colectomy for the prevention of recurrent volvulus.

Endoscopic fixation of the sigmoid colon may be considered in selected patients in whom operative intervention presents a prohibitive risk.

Attempts at endoscopic reduction of cecal volvulus are generally not recommended.

Segmental resection is the preferred treatment for patients with cecal volvulus.

For cecal volvulus with viable bowel, the use of nonresectional operative procedures should be limited to patients who are considered unfit for resection.

Initial evaluation should include a focused history and physical examination, baseline laboratory values, and diagnostic imaging.

Initial treatment of ACPO is supportive and includes eliminating or correcting conditions that predispose patients to ACPO or prolong its course.

Pharmacologic treatment with neostigmine is indicated when ACPO does not resolve with supportive therapy.

Endoscopic colonic decompression should be considered in patients with ACPO in whom neostigmine therapy is contraindicated or ineffective.

Operative treatment is recommended for ACPO complicated by colon ischemia or perforation or ACPO refractory to pharmacologic and endoscopic therapies.