Guidance issued for colonic volvulus, acute colonic pseudo-obstruction

(HealthDay)-Clinical practice guidelines published in the September issue of the American Association of Colorectal Surgeons Diseases of the colon and rectumRecommendations for the management of volvulus of the colon and acute colonic pseudoocclusion (ACPO) are presented.

Karim Alavi, MD, MPH and colleagues at the University of Massachusetts School of Medicine in Worcester have made 15 recommendations related to the diagnosis and treatment of colonic torsion and the evaluation and treatment of ACPO.

The authors recommend including a medical history focused on the initial assessment of volvulus of the colon. Physical examination, And basic laboratory evaluation.Torsion of the colon is often assessed initially with hemodynamics and a simple abdominal x-ray. Stable patientAlthough computed tomography images may be used to confirm the diagnosis.Lower endoscopy must be performed to evaluate sigmoids colon In patients with no evidence of hemodynamic instability, peritonitis, or perforation, it enhances viability, distorts the anatomy, and decompresses the colon. If endoscopic twisting of the sigmoid colon fails, and if the colon is non-viable or perforated, emergency sigmoid resection is indicated. Attempts at endoscopic reduction are generally not recommended for cecal volvulus. The preferred treatment is partial resection. For ACPO, the initial assessment should include a focused medical history and physical examination, baseline test values, and diagnostic imaging. Initial treatment is supportive and involves eliminating or correcting conditions that predispose the patient to prolong the course of ACPO.

In a statement, the co-author stated, “These recommendations provide the basis for a scientifically informed approach to managing these serious conditions, always informed at the discretion of the physician, and individual patients. I hope it will be adjusted to suit the situation. ”

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