Operative therapy for colonic volvulus

Colonic volvulus may occur in any portion of the colon from the ileocecal valve to the rectosigmoid junction. Endoscopic decompression of the sigmoid colon is often successful and should be followed by elective sigmoid colon resection in patients who are good surgical candidates. Failure of nonoperative decompression or evidence of ischemic bowel are indications for emergent surgical intervention. Volvulus of the cecum and transverse colon is rarely amenable to endoscopic decompression. The procedure of choice for both cecal and transverse colon volvulus is resection with either primary anastomosis or enterostomy and mucus fistula. Postoperative mortality is increased with emergent surgery and the presence of ischemic bowel.