Management of colonic volvulus: A retrospective analysis of short-term outcomes

Colonic volvulus is the third most common cause of colonic obstruction globally. The management of colonic volvulus, comprising emergency surgery, endoscopic decompression, elective surgery following endoscopic decompression, and the specific surgical approach directly influences morbidity and mortality in these critically ill patients. This study aims to present the outcomes of patients with colonic volvulus treated at our institution. A retrospective analysis was conducted on 47 patients treated for sigmoid volvulus at our clinic between 2017-2024. The study examined demographic data, preoperative radiological assessments, management strategies for volvulus, and postoperative outcomes. The median age of the 47 patients diagnosed and treated for colonic volvulus was 73 years (25th and 75th percentiles: 55-79), with 83% of the patients being male. Endoscopic detorsion was performed in 66% of the patients, and the overall morbidity rate in the treated population was 34%, while the mortality rate was 12.8%. Univariate analyses revealed that factors such as pH, lactate, CRP, creatinine, BUN, bowel necrosis, perforation, and endoscopic detorsion were associated with morbidity. Multivariate analysis indicated that endoscopic detorsion was the only factor that significantly reduced morbidity (p=0.01). In sigmoid volvulus, endoscopic detorsion in patients without signs of perforation is the most important independent risk factor for reducing morbidity in the treatment algorithm. Therefore, it should be considered the first-line treatment option by clinicians.