Colonic volvulus – epidemiology, management and outcome

Introduction Colonic volvulus mainly affects caecum (CV) and sigmoid colon (SV). This study described clinical characteristics and treatments in a modern cohort. Method A retrospective cohort study across the Swedish Southeast healthcare region (population 1.1 million) identified patients diagnosed with colonic volvulus 2010–2022 with review of medical records. Result In total, 442 patients with a first episode of colonic volvulus were included – 202 CV, 240 SV; none in other colon segments. The annual incidence was 3.26 per 100,000 (CV 1.77; SV 1.49), unaltered over the studied period. CV affected more women (65%) and younger patients (median 64.8 vs. 73.6 years (p<0.001)), while SV predominately affected men (79%, p<0.001). Prior abdominal surgery was more common in CV, whereas neurological and psychiatric conditions, constipation, and nursing home residency were more frequent in SV (p<0.05 for all). CV was treated with emergency surgery in 99%. First-line treatment of the first SV episode was mainly non-operative (contrast enema 78%, endoscopy 7%, spontaneous resolution 4%), successful in 82%. Emergency surgery was first-line treatment in 11% and second-line in 13% (failed non-operative treatment). Among 152/53/21/16/10 patients treated without emergency or elective surgery for a first/second/third/fourth/fifth SV episode, increasing recurrence rates of 62%/77%/90%/88%/100% were observed (p for trend <0.001). The 90-day mortality after emergency surgery was 6% for CV and 13% for SV (p=0.89), and 6% after elective SV surgery (p=0.25). Discussion Initial therapy is normally surgery in CV and non-operative in SV. The risk of recurrence increases with each SV episode, why elective surgery should be considered after recurrent SV.