Volvulus du côlon : quelle prise en charge en 2016 ?

Colonic volvulus represents the third cause of large bowel obstruction worldwide, and has two main locations: sigmoid and cecum. In Western countries, sigmoid volvulus affects preferentially elderly men whereas cecum volvulus affects younger women. There are common risk factors to different locations, such as chronic constipation, high-fiber diet, frequent use of laxative, personal past history of laparotomy and anatomic predispositions. Clinical presentation is nonspecific, and associates frequently abdominal pain, meteorism and bowel obstruction. Abdomino-pelvic CT-scan is currently the gold standard examination, allowing positive diagnosis and detection of complications. Management depends on the volvulus location, patient's comorbidities and colon viability, but remains an emergency in every case. In case of clinico-radiological gravity signs, an emergency surgery has to be done, but exposes to high morbidity and mortality rates. In sigmoid locations and without gravity criteria, the ideal strategy is an endoscopic detwisting procedure followed, within 2 to 5 days, by a surgery including a sigmoidal resection-anastomosis. Exclusive endoscopic treatments must be reserved for patients with an excessive surgical risk. In cecal volvulus, there is no place for endoscopy and surgery must be routine.