title: Management of the colonic volvulus in 2016.
abstract: Colonic volvulus is the third leading cause of colonic obstruction worldwide, occurring at two principal locations: the sigmoid colon and cecum. In Western countries, sigmoid volvulus preferentially affects elderly men whereas cecal volvulus affects younger women. Some risk factors, such as chronic constipation, high-fiber diet, frequent use of laxatives, personal past history of laparotomy and anatomic predispositions, are common to both locations. Clinical symptomatology is non-specific, including a combination of abdominal pain, gaseous distention, and bowel obstruction. Abdominopelvic computerized tomography is currently the gold standard examination, allowing positive diagnosis as well as detection of complications. Specific management depends on the location, patient comorbidities and colonic wall viability, but treatment is an emergency in every case. If clinical or radiological signs of gravity are present, emergency surgery is mandatory, but is associated with high morbidity and mortality rates. For sigmoid volvulus without criteria of gravity, the ideal strategy is an endoscopic detorsion procedure followed, within 2 to 5 days, by surgery that includes a sigmoid colectomy with primary anastomosis. Exclusively endoscopic therapy must be reserved for patients who are at excessive risk for surgical intervention. In cecal volvulus, endoscopy has no role and surgery is the rule.
authors.affiliation: Service de chirurgie viscérale et digestive, centre hospitalier régional et universitaire, avenue de la Côte-de-Nacre, 14000 Caen, France. Electronic address: laurentperrot@hotmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Perrot
authors.affiliation: Service de radiologie, centre hospitalier régional et universitaire, avenue de la Côte-de-Nacre, 14000 Caen, France.
authors.forename: A
authors.initials: A
authors.lastname: Fohlen
authors.affiliation: Service de chirurgie viscérale et digestive, centre hospitalier régional et universitaire, avenue de la Côte-de-Nacre, 14000 Caen, France.
authors.forename: A
authors.initials: A
authors.lastname: Alves
authors.affiliation: Service de chirurgie viscérale et digestive, centre hospitalier régional et universitaire, avenue de la Côte-de-Nacre, 14000 Caen, France.
authors.forename: J
authors.initials: J
authors.lastname: Lubrano
mesh_terms: D003082:Colectomy; D003108:Colonic Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003113:Colonoscopy; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D045822:Intestinal Volvulus / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Cecum; Colon; Endoscopy; Sigmoid; Volvulus