Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction

Publication Date: August 31, 2021
Last Updated: March 14, 2022

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

(1C)
312133

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

(1C)
312133

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.

(1C)
312133

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

(1C)
312133

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

(1C)
312133

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

(2C)
312133

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

(2C)
312133

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

(1C)
312133

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

(1C)
312133

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

(2C)
312133

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

(1C)
312133

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

(1C)
312133

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

(1B)
312133

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

(1B)
312133

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

(1C)
312133

Recommendation Grading

Overview

Title

Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction

Authoring Organization

American Society of Colon and Rectal Surgeons

Publication Month/Year

August 31, 2021

Last Updated Month/Year

August 29, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult

Health Care Settings

Ambulatory, Hospital

Intended Users

Physician, nurse practitioner, nurse, physician assistant

Scope

Prevention, Management

Diseases/Conditions (MeSH)

D003112 - Colonic Pseudo-Obstruction

Keywords

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

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.

Methodology

Number of Source Documents
126
Literature Search Start Date
December 31, 2013
Literature Search End Date
January 18, 2021