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Colonic volvulus: presentation and management in metropolitan Minnesota, United States.

BACKGROUND: Management approaches for colonic volvulus are infrequently described in the literature in the United States, and many studies only report operative cases.

OBJECTIVE: The aim of this study was to define the demographics, diagnostic and treatment approaches, and outcomes for patients with this disorder in the United States.

DESIGN: This study is a retrospective review.

SETTINGS: The study was conducted at a 7-hospital health system.

PATIENTS: All patients diagnosed with colonic volvulus by International Classification of Diseases, Ninth Revision code were included.

MAIN OUTCOME MEASURES: The primary outcomes measured were recurrence, complications, and mortality.

RESULTS: One hundred three cases of volvulus (50 sigmoid, 53 cecal) were identified in 92 patients. Compared with cecal volvulus, sigmoid volvulus was more common in men, patients with neurologic diagnoses, and residents of skilled nursing home. Eighty-five percent of the cases presented were acutely obstructed. The diagnosis was established by abdominal x-ray (17%), contrast enema study (27%), CT scan (35%), or laparotomy (17%). Abdominal x-rays were insufficient for definitive diagnosis in 85% of cecal and 49% of sigmoid cases (p = 0.002). All patients with cecal volvulus were treated surgically. Seventy-nine percent of patients with sigmoid volvulus underwent successful nonoperative reduction, of whom 38% had subsequent surgery. Fifty-eight percent of patients with sigmoid volvulus were treated operatively. Resection with primary anastomosis was chosen in most cases (78%). Resection with end ostomy (10%), reduction and pexy (7%), and reduction alone (4%) were other approaches. The mortality rate was 5% (cecal 0%, sigmoid 10%; p = 0.012). There were no readmissions for recurrent cecal volvulus. Nonoperative treatment for sigmoid volvulus often failed (48%). Complication rates were higher in sigmoid volvulus cases (cecal 17%, sigmoid 34%; p = 0.047).

LIMITATIONS: This study was limited by its retrospective, nonexperimental design.

CONCLUSIONS: Although incidences of cecal and sigmoid volvulus are similar in the present series, sigmoid volvuli are more common in men, individuals with neurologic disease, and residents of nursing homes. Plain radiograph is insufficient to confirm cecal volvulus. The diagnosis is most often made with CT scans. The nonoperative management of sigmoid volvulus is associated with a high recurrence rate.

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