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Colonic volvulus

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Updated 2023 WSES guidelines for the diagnosis and management of colonic volvulus.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of colonic volvulus are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES 2023), the American Society for Gastrointestinal Endoscopy (ASGE 2020), and the American Society of Colon and Rectal Surgeons (ASCRS 2016). ...
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Diagnostic investigations

Initial evaluation: as per WSES 2023 guidelines, elicit a focused history, perform a physical examination, and obtain a full panel of blood tests (including blood gas and lactate levels to assess for bowel ischemia) in the initial evaluation of patients with suspected sigmoid volvulus.
B
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  • Diagnostic imaging

Therapeutic procedures

Endoscopic detorsion, sigmoid volvulus
As per WSES 2023 guidelines:
Perform flexible endoscopy as the first-line treatment modality to decompress the sigmoid colon if ischemia or perforation is not suspected clinically and/or radiologically.
B
Consider performing endoscopic fixation of the sigmoid colon in selected patients with a prohibitive risk for operative interventions.
C

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  • Endoscopic detorsion (cecal volvulus)

Surgical interventions

Operative management, sigmoid volvulus: as per WSES 2023 guidelines, perform urgent sigmoid resection when endoscopic detorsion of the sigmoid colon is unsuccessful and in cases of a nonviable or perforated colon.
B
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  • Operative management (cecal volvulus)

Specific circumstances

Pregnant patients: as per WSES 2023 guidelines, recognize that colonic volvulus is rare during pregnancy. Use a multidisciplinary approach to treatment, taking into account the stage of pregnancy.
B

Preventative measures

Prevention of recurrence: as per ASCRS 2016 guidelines, consider performing sigmoid colectomy after resolution of the acute phase of sigmoid volvulus for the prevention of recurrent volvulus.
B
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