Prognosis

Large bowel obstruction from all causes is associated with appreciable mortality and morbidity owing to the nature of the disease process, and to the health of the patient groups affected.

Colonic volvulus

Data from the US Nationwide Inpatient Sample (2002-2010) suggest mortality rates of 9.4% and 6.6% following operative intervention (including resective procedures and operative detorsion with/without fixation procedures) for patients admitted emergently with sigmoid volvulus and cecal volvulus, respectively.[21] Retrospective studies report significant mortality (around 12% but can be up to 57% in some cases) following Hartmann procedure for acute sigmoid volvulus.[8]​[50][51]​​[52]

Patients with sigmoid volvulus who undergo successful endoscopic detorsion without subsequent intervention have a 43% to 84% recurrence rate, and patients with recurrent volvulus are again at risk for bowel ischemia and morbidity.[8][26]​​[77][78]​​​​ The high risk for recurrent volvulus, and the potential morbidity and mortality associated with each recurrent episode, specifically in the frail, older adult population, support the recommendation for operative intervention during patients’ index admission, or soon thereafter.[3][13]

Colorectal malignancy

Colorectal malignancy with obstruction carries an appreciable morbidity and mortality and is likely to have an adverse effect on long-term prognosis. A reduced 5-year survival has been reported in this group of patients.[79]

Rare causes

For rare causes (e.g., benign stricture, foreign body ingestion), the underlying disease process dictates the long-term outcome.

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