ASCRS Guideline Updates on Colonic Volvulus and Acute Colonic Pseudo-Obstruction

The American Society of Colon and Rectal Surgeons (ASCRS) has updated its guidelines on the diagnosis, treatment, and management of colonic volvulus and acute colonic pseudo-obstruction (ACPO, or Ogilvie syndrome) in adults.

These recommendations are an update to the group’s 2016 guidelines. The ASCRS Clinical Practice Guidelines Committee used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system to review 125 research reports from January 2014 to January 2021.

Among the 15 updated recommendations are:

• A focused history, physical examination, and basic laboratory assessment should be included in the initial evaluation for suspected colon volvulus, since presenting symptoms such as peritonitis, shock, or abdominal tenderness may be nonspecific. (1c recommendation)
• Plain abdominal radiographs and computed tomography imaging with or without rectal contrast should be used to confirm a suspected colon volvulus diagnosis. (1c recommendation)
• To prevent recurring volvulus, patients who had successful endoscopic detorsion should also be considered for sigmoid colectomy during the same hospital admission. (1c recommendation)
• A focused history, physical examination, baseline laboratory values, and diagnostic imaging should be included in the initial evaluation for suspected ACPO. (1c recommendation)
• Supportive treatment, such as eliminating or correcting symptoms that worsen ACPO, should be used when initially treating ACPO. If unsuccessful, pharmacologic treatment with neostigmine is recommended. (1c and 1b recommendations)

—Leigh Precopio

Reference:

Alavi K, Poylin V, Davids JS, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colonic volvulus and acute colonic pseudo-obstruction. Dis Colon Rectum. 2021;64(9):1046-1057. https://doi.org/10.1097/dcr.0000000000002159