Volvulus Management Guidelines

Introduction to Volvulus Management

The American College of Surgeons recommends immediate surgical intervention for cecal volvulus, with right hemicolectomy as the definitive treatment, and notes that endoscopy has no role in cecal volvulus management 1, 2
The World Journal of Emergency Surgery suggests that for sigmoid volvulus without ischemia or perforation, endoscopic decompression should be performed immediately followed by definitive sigmoid resection during the same hospital admission 1, 3

The World Journal of Emergency Surgery recommends that for uncomplicated sigmoid volvulus, first-line treatment is endoscopic decompression with a 70-91% success rate, followed by mandatory definitive sigmoid resection during the same hospital admission after successful decompression 1, 3
The guideline society suggests that without resection, recurrence rates are high at 45-71%, and each recurrence increases the risk of ischemia, perforation, and mortality 3
Exclusively endoscopic therapy without subsequent surgery should only be reserved for patients with prohibitive surgical risk, as stated by the World Journal of Emergency Surgery 1

The World Journal of Emergency Surgery states that cecal volvulus requires immediate surgical intervention, with right hemicolectomy as the only definitive treatment 1, 2
The guideline society notes that endoscopy has no role in cecal volvulus management 1, 2

The guideline society identifies age over 60 years, presence of shock on admission, and history of previous volvulus episodes as significant risk factors for increased mortality 3
Patients with neuropsychiatric conditions on chronic psychotropic medications are at higher risk for sigmoid volvulus, according to the guideline society 4

Endoscopic decompression is the recommended initial treatment for uncomplicated sigmoid volvulus in elderly patients with chronic constipation, as supported by the World Journal of Emergency Surgery. 5

Clinicians must avoid confusing midgut volvulus with sigmoid volvulus; the former involves the small intestine and requires emergency surgery, whereas the latter affects the large bowel and can be managed endoscopically. This distinction is emphasized in the World Journal of Emergency Surgery. 5

Poor postoperative outcomes are associated with patients older than 60 years, those presenting in shock, and delayed presentation that permits bowel ischemia to develop, according to evidence from the World Journal of Emergency Surgery. 5