Management of Colonic Volvulus and Intestinal Obstruction

Colonic volvulus and related forms of intestinal obstruction represent a significant surgical emergency that may rapidly progress to ischaemia, perforation and sepsis if not promptly recognised and treated. Colonic volvulus arises when a segment of colon, most often the sigmoid, twists around its mesentery, obstructing luminal flow and vascular supply. Small bowel volvulus and ileo-sigmoid knotting similarly produce mechanical obstruction but are less prevalent. Clinical presentation typically includes acute abdominal pain, distension, constipation and vomiting, with systemic signs of dehydration and shock in advanced cases. Initial management mandates resuscitation with fluid replacement, correction of electrolyte imbalance and prompt imaging—plain radiography may reveal dilated loops and air-fluid levels, while CT offers characteristic whirlpool and bird-beak signs. In uncomplicated cases of colonic volvulus without evidence of gangrene or perforation, flexible endoscopic detorsion is the treatment of choice, offering rapid decompression and symptom relief. Definitive management may follow in the elective setting, usually by sigmoid resection and primary anastomosis to prevent recurrence. Emergency surgical intervention is indicated in cases of failed endoscopic reduction, peritonitis or non-viable bowel; options include resection with primary anastomosis, Hartmann’s procedure or creation of a stoma, depending on patient stability and bowel viability. In small bowel volvulus and ileo-sigmoid knotting, urgent laparotomy is essential, with resection of necrotic segments and restoration of continuity favored where feasible. Across all presentations, patient comorbidity, timing of intervention and choice of procedure are key determinants of morbidity and mortality.

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Management of Colonic Volvulus and Intestinal Obstruction publication trend

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Technical terms

Colonic volvulus: Torsion of the colon around its mesenteric axis causing obstruction and potential ischaemia.

Endoscopic detorsion: Non-surgical reduction of a twisted bowel segment using flexible endoscopy.

Anastomosis: Surgical reconnection of two intestinal segments after resection.

Hartmann’s procedure: Resection of a diseased colon segment with creation of a proximal stoma and closure of the distal stump.

Ileo-sigmoid knot: Concomitant twisting of ileum and sigmoid colon forming a compound volvulus.

References

1. WSES consensus guidelines on sigmoid volvulus management. World Journal of Emergency Surgery (2023).
2. Sigmoid volvulus: outcomes of treatment and predictors of morbidity and mortality. Langenbeck's Archives of Surgery (2022).
3. Sigmoid volvulus: An update for Atamanalp classification. Pakistan Journal of Medical Sciences (2020).