• Brian R Swenson, Mary R Kwaan, Nora E Burkart, Yan Wang, Robert D Madoff, David A Rothenberger, and Genevieve B Melton.
• Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
• Dis. Colon Rectum. 2012 Apr 1;55(4):444-9.

BackgroundManagement approaches for colonic volvulus are infrequently described in the literature in the United States, and many studies only report operative cases.ObjectiveThe aim of this study was to define the demographics, diagnostic and treatment approaches, and outcomes for patients with this disorder in the United States.DesignThis study is a retrospective review.SettingsThe study was conducted at a 7-hospital health system.PatientsAll patients diagnosed with colonic volvulus by International Classification of Diseases, Ninth Revision code were included.Main Outcome MeasuresThe primary outcomes measured were recurrence, complications, and mortality.ResultsOne hundred three cases of volvulus (50 sigmoid, 53 cecal) were identified in 92 patients. Compared with cecal volvulus, sigmoid volvulus was more common in men, patients with neurologic diagnoses, and residents of skilled nursing home. Eighty-five percent of the cases presented were acutely obstructed. The diagnosis was established by abdominal x-ray (17%), contrast enema study (27%), CT scan (35%), or laparotomy (17%). Abdominal x-rays were insufficient for definitive diagnosis in 85% of cecal and 49% of sigmoid cases (p = 0.002). All patients with cecal volvulus were treated surgically. Seventy-nine percent of patients with sigmoid volvulus underwent successful nonoperative reduction, of whom 38% had subsequent surgery. Fifty-eight percent of patients with sigmoid volvulus were treated operatively. Resection with primary anastomosis was chosen in most cases (78%). Resection with end ostomy (10%), reduction and pexy (7%), and reduction alone (4%) were other approaches. The mortality rate was 5% (cecal 0%, sigmoid 10%; p = 0.012). There were no readmissions for recurrent cecal volvulus. Nonoperative treatment for sigmoid volvulus often failed (48%). Complication rates were higher in sigmoid volvulus cases (cecal 17%, sigmoid 34%; p = 0.047).LimitationsThis study was limited by its retrospective, nonexperimental design.ConclusionsAlthough incidences of cecal and sigmoid volvulus are similar in the present series, sigmoid volvuli are more common in men, individuals with neurologic disease, and residents of nursing homes. Plain radiograph is insufficient to confirm cecal volvulus. The diagnosis is most often made with CT scans. The nonoperative management of sigmoid volvulus is associated with a high recurrence rate.

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