Incidence and recurrence risk of colonic volvulus—a population-based cohort study

Introduction

Recurrence risk affects management of colonic volvulus but whether it increases with repeated episodes is unknown.

Methods

A retrospective cohort study across the Swedish Southeast healthcare region (population 1.1 million) identified all patients diagnosed with colonic volvulus 2010–2022 with review of medical records.

Results

442 patients with a first CT-verified episode of colonic volvulus were included; 202 caecal volvulus (CV) and 240 sigmoid volvulus (SV). The annual incidence was 3.26 per 100 000 (CV 1.77; SV 1.49)) and did not change over time. CV predominantly affected women (80.2%) and younger patients (median 64.8 versus 73.6 years (P < 0.001)), while SV were more frequent in men (64.2%, P < 0.001). Prior abdominal surgery was more common in CV. Neurological and psychiatric conditions, constipation, and nursing home residence were more frequent in SV.

CV was treated with emergency surgery in 98.0%. In SV, first-line treatment of the index episode was mainly non-operative management (NOM; contrast enema 78.3%, endoscopy 7.1%) successful in 86.8%. A further 3.8% resolved spontaneously. Emergency surgery was first-line treatment in 10.8% and second-line after failed NOM in 11.3%. The 1-year recurrence risk after NOM was 54.7% (95% c.i. 46.5–63.4%) after the index episode but gradually increased with each repeated episode to 92.2% (70.5–99.5%) after the fourth (adjusted hazard ratio 2.8 (1.5–5.1)).

Recurrence after surgery was rare (n = 3).

Discussion

NOM is successful in most SV but the recurrence risk increases with each repeated episode. Elective surgery should be considered after a second episode but balanced against frailty.