Role of Endoscopy in the Management of Acute Colonic Pseudo-Obstruction and Colonic Volvulus

RECOMMENDATIONS

1. 1

   For patients with uncomplicated sigmoid volvulus, we suggest endoscopy as the initial treatment modality. After successful detorsion, placement of decompression tube should be considered to maintain reduction and decrease risk of recurrence.

   Patients concernés: Patients with uncomplicated sigmoid volvulusSituation: Uncomplicated sigmoid volvulus

   ÞþTreatment

2. 2

   For patients with sigmoid volvulus, we suggest surgical consultation during index admission given the high risk of recurrent volvulus and high morbidity and mortality associated with each episode.

   Patients concernés: Patients with sigmoid volvulusSituation: Sigmoid volvulus

   ÞþþManagement

3. 3

   For patients with cecal volvulus, we recommend pursuit of surgical management as initial treatment modality and avoidance of endoscopic intervention given the high risk of perforation.

   Patients concernés: Patients with cecal volvulusSituation: Cecal volvulus

   ÞþþTreatment

4. 4

   For patients with colon volvulus with overt perforation or signs of peritonitis, we recommend surgical management.

   Patients concernés: Patients with colon volvulus with overt perforation or signs of peritonitisSituation: Colon volvulus with overt perforation or signs of peritonitis

   ÞþþTreatment

5. 5

   For patients with uncomplicated ACPO (absence of ischemia, peritonitis, cecal diameter <12 cm, and/or significant abdominal pain), we recommend conservative therapy as the preferred initial management including identifying and correcting potentially contributing metabolic, infectious, and pharmacologic factors.

   Patients concernés: Patients with uncomplicated ACPOSituation: Uncomplicated acute colonic pseudo-obstruction (ACPO)

   ÞþþTreatment

6. 6

   For patients with ACPO who are not candidates for conservative therapy, have failed conservative therapy (up to 72 hours), or are at risk for perforation and have no contraindication to its use, we recommend pharmacologic therapy with neostigmine (2 mg over 3-5 minutes) with appropriate cardiovascular monitoring.

   Patients concernés: Patients with ACPO not candidates for or failing conservative therapySituation: Acute colonic pseudo-obstruction (ACPO)

   ÞþþTreatment

7. 7

   For patients with ACPO who do not respond to a first dose of neostigmine, we suggest the administration of a second dose of neostigmine.

   Patients concernés: Patients with ACPO who do not respond to a first dose of neostigmineSituation: Acute colonic pseudo-obstruction (ACPO)

   ÞTreatment

8. 8

   For patients with ACPO refractory to bolus dosing of neostigmine, we suggest alternative routes of neostigmine administration including subcutaneous or continuous intravenous infusion.

   Patients concernés: Patients with ACPO refractory to bolus dosing of neostigmineSituation: Acute colonic pseudo-obstruction (ACPO)

   ÞTreatment