eP522 - Examination of Possible Risk Factors Associated with Incidence of Cecal Volvulus Within the United States

Purpose/Background: The overall incidence rate of colonic volvulus has been reported to be 1.9% of all-cause bowel obstructions with a question of increasing incidence of cecal volvulus (Halabi et al, 2014). This disease process is seen frequently in our private practice within Salt Lake City, UT. We sought to identify potential risk factors for cecal volvulus. Historically, colonic volvulus has been shown to be more prevalent in sub-Sahara Africa which could be attributed to a multitude of reasons (diet, ethnicity, climate). We wanted to examine different geographical areas of US based on climate and examine if cecal volvulus was more prevalent in dry, arid climates. Secondarily, it has also been postulated in prior literature that perhaps prior pelvic surgery could lead to increase rate of cecal volvulus as its incidence is high in middle age women (Halabi et al, 2014). However, we hypothesize that most cases of pelvic surgery would lead to increased pelvic scar tissue without the need for lateral mobilization of the cecum and thus would be associated with decreased incidence of cecal volvulus.Methods/Interventions: A Retrospective review of all patients within HCA affiliated hospitals in US admitted with bowel obstruction from 2017-present. Of that cohort, the incidence of cecal volvulus was determined by extracting CD code k56.2 (Volvulus) since there is no specific ICD code to distinguish between cecal or sigmoid volvulus. Next, we examined those that underwent right colectomy (CPT 44160) or laparoscopic ileocecectomy (CPT 44205) in order to identify the cecal volvulus patients. Within the cecal volvulus population we then examined if female subjects had prior OB/GYN, pelvic surgeries prior to their presentation and operative intervention for cecal volvulus. Incidence was reported as number of persons who presented with cecal volvulus and underwent surgical intervention that admission per 100,000 admissions in the respective geographical area.Arid states were defined on data published by American Meteorological Society and included the states of Wyoming, Utah, Nevada, California, Arizona, New Mexico, Colorado, and Texas.Results/Outcomes: 697 patients were identified with k56.2 Volvulus ICD code who underwent either an open right colectomy or laparoscopic ileocectomy. Of those 697 patients, 293 patients presented in an “Arid state”. There was a 20% increase in incidence of cecal volvulus in “Arid” states when compared to “non-arid” states. Only 49 of the 231 female cecal volvulus patients had prior gynecologic pelvic surgery performed. This equated to a 73% lower incidence rate of cecal volvulus occurring in females with prior gynecologic pelvic surgery.Conclusion/

Discussion: The results of this retrospective study demonstrate an increased incidence rate of cecal volvulus occurring in admissions within an “Arid” state and show that prior pelvic gynecologic surgery may contribute to lower incidence of cecal volvulus in the female population."Table 1

Incidence in Arid v. Non-Arid states

Prior Pelvic Surgery in Females
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