Morbidity and mortality in patients with colonic volvulus—a population-based cohort study

Introduction

Morbidity and mortality rates after surgery for colonic volvulus are largely 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 episode of CT-verified colonic volvulus were included; 202 caecal (CV) and 240 sigmoid volvulus (SV). Virtually all CV patients underwent surgery (198 emergency, 3 elective); 94.4% with ileocaecal resection/right hemicolectomy, 4.5% with caecopexy. Emergency surgery was performed in 53 (22.1%) patients during their first or subsequent SV episodes and 104 (43.3%) underwent elective sigmoid resection.

After emergency resection, primary anastomosis was more common in CV than SV (87.2 versus 34.6%; P < 0.001). In SV, anastomosis was more frequent after elective (69.2%) than emergency surgery (OR 4.3, 95% c.i. 2.1–8.6).

The 30-day mortality after non-operative management (NOM) of an index SV episode was 8.8%. After emergency surgery for CV and SV, CD≥3 complications occurred in 15.2 and 32.1% (P = 0.005) including 30-day mortality 3.0 and 5.7% (P = 0.40). After elective SV surgery CD≥3 occurred in 18.4% including 30-day mortality 3.8%.

One year after the index episode, 86.4% of CV patients were alive, 73.6% after emergency SV surgery and 63.7% of non-operated patients.

Discussion

Emergency resection with anastomosis is often safe in CV. Complications are more frequent in emergency SV surgery despite a higher stoma rate. Outcomes are more favourable after elective SV surgery. 30-day and 1-year survival were worse in NOM patients, likely reflecting selection bias.