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Colonic Volvulus in the United States: Trends, Outcomes, and Predictors of Mortality

Halabi, Wissam J. MD*; Jafari, Mehraneh D. MD*; Kang, Celeste Y. MD*; Nguyen, Vinh Q. PhD; Carmichael, Joseph C. MD*; Mills, Steven MD*; Pigazzi, Alessio MD, PhD*; Stamos, Michael J. MD*

doi: 10.1097/SLA.0b013e31828c88ac
Original Articles

Introduction: Colonic volvulus is a rare entity associated with high mortality rates. Most studies come from areas of high endemicity and are limited by small numbers. No studies have investigated trends, outcomes, and predictors of mortality at the national level.

Methods: The Nationwide Inpatient Sample 2002–2010 was retrospectively reviewed for colonic volvulus cases admitted emergently. Patients' demographics, hospital factors, and outcomes of the different procedures were analyzed. The LASSO algorithm for logistic regression was used to build a predictive model for mortality in cases of sigmoid (SV) and cecal volvulus (CV) taking into account preoperative and operative variables.

Results: An estimated 3,351,152 cases of bowel obstruction were admitted in the United States over the study period. Colonic volvulus was found to be the cause in 63,749 cases (1.90%). The incidence of CV increased by 5.53% per year whereas the incidence of SV remained stable. SV was more common in elderly males (aged 70 years), African Americans, and patients with diabetes and neuropsychiatric disorders. In contrast, CV was more common in younger females. Nonsurgical decompression alone was used in 17% of cases. Among cases managed surgically, resective procedures were performed in 89% of cases, whereas operative detorsion with or without fixation procedures remained uncommon. Mortality rates were 9.44% for SV, 6.64% for CV, 17% for synchronous CV and SV, and 18% for transverse colon volvulus. The LASSO algorithm identified bowel gangrene and peritonitis, coagulopathy, age, the use of stoma, and chronic kidney disease as strong predictors of mortality.

Conclusions: Colonic volvulus is a rare cause of bowel obstruction in the United States and is associated with high mortality rates. CV and SV affect different populations and the incidence of CV is on the rise. The presence of bowel gangrene and coagulopathy strongly predicts mortality, suggesting that prompt diagnosis and management are essential.

Colonic volvulus is a rare cause of bowel obstruction in the United States. Cecal and sigmoid volvulus affect different populations. Although the incidence of cecal volvulus is increasing, that of sigmoid volvulus remains stable. Mortality rates after operation for volvulus are predicted by bowel viability, coagulopathy, and renal failure.

*Department of Surgery, University of California Irvine Medical Center, Orange, CA; and

Department of Statistics, University of California Irvine, Irvine, CA.

Reprints: Michael J. Stamos, MD, Department of Surgery, University of California Irvine Medical Center 333 City Boulevard, West Suite 700, Orange, CA 92868. E-mail:

Disclosure: The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.