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CASE REPORT
Year : 2015  |  Volume : 3  |  Issue : 2  |  Page : 47-49

Cecal volvulus: Case report and review of literature


Department of General Surgery, King Khalid Hospital, Hail, Saudi Arabia

Date of Web Publication1-Feb-2016

Correspondence Address:
Alaa Sedik
Department of General Surgery, King Khalid Hospital, Hail
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3846.175211

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  Abstract 


Cecal volvulus as an uncommon cause of acute intestinal obstruction is due to axial twist of the cecum and terminal ileum around their mesentery. Cecal volvulus is a surgical emergency requiring urgent laparotomy. Resection and anastomosis is the proposed choice of the operation depending on the general condition of the patient. In addition, to its rarity, lack of familiarity causes diagnostic doubt and consequently delays in treatment. In this paper, we report a case of cecal volvulus seen in a 31-year-old Saudi male presented with vomiting, abdominal pain, and distension.

Keywords: Abdominal pain, cecum, intestinal obstruction, volvulus


How to cite this article:
Sedik A, Bar EA, Ismail M. Cecal volvulus: Case report and review of literature. Saudi Surg J 2015;3:47-9

How to cite this URL:
Sedik A, Bar EA, Ismail M. Cecal volvulus: Case report and review of literature. Saudi Surg J [serial online] 2015 [cited 2020 Aug 8];3:47-9. Available from: http://www.saudisurgj.org/text.asp?2015/3/2/47/175211




  Introduction Top


Cecal volvulus is a rare cause of intestinal obstruction.[1] Although it generally presents as a small bowel obstruction,[2] clinical symptoms, signs, and routine laboratory tests are not specific to the disease,[3] while computed tomography (CT) is more diagnostic.[4] Surgical intervention is the only treatment of cecal volvulus.[1] The prognosis of the disease may be poor with a 0–40% mortality rate depending on the bowel viability or gangrene.[1],[3] In this report, we present a 31-year-old patient with cecal volvulus with mobile cecum and incomplete visceral rotation.


  Case Report Top


A 31-year-old Saudi male admitted to the Emergency Department with 1 day history of colicky abdominal pain, vomiting, and distension. There was a history of similar attack 6 years ago that was passed spontaneously. As regards clinical examination, it demonstrated a distended tender abdomen with hyperactive bowel sounds. Laboratory works were within normal limits. Plain abdominal X-ray [Figure 1] and plain CT of the abdomen confirmed the diagnosis of a cecal volvulus [Figure 2]. The patient was consented for surgery and situation discussed.
Figure 1: Supine plain X-ray abdomen showing a hugely dilated loop

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Figure 2: Computed tomography abdomen, cecal volvulus

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An urgent laparotomy was performed after a proper resuscitation. Operative findings demonstrated a viable cecal volvulus with terminal ileum and right colon [Figure 3] and [Figure 4]. Cecum was mobile and visceral rotation was incomplete. A limited right hemicolectomy was performed and intestinal continuity was restored by an stapled ileoascending anastomosis. Postoperatively, the patient did well except for minor anastomotic hemorrhage when the bowel started to move. He was managed conservatively and discharged on the 7th day in good condition for outpatient follow-ups. Histopathological examination reported the same findings.
Figure 3: Intraoperative findings: viable cecal volvulus

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Figure 4: A photo of the resected specimen (including terminal ileal piece. Cecum, proximal ascending colon, the appendix is also shown)

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  Discussion Top


Cecal volvulus is caused by axial twisting of the cecum along with the terminal ileum and ascending colon.[2] It is responsible for approximately 1–1.5% of all intestinal obstructions, while 11% of all volvulus-related intestinal obstructions and its incidence is 2.8–7.1 cases per million annually.[1] Most of the cecal volvulus reports are from Asia,[1],[5],[6] and the disease occurs less frequently than sigmoid volvulus,[2] which is also common in Asia. The present patient is our only cecal volvulus case in the recent 10 years. Many factors have been referred as correlated to cecal volvulus development, mainly anatomical predispositions such as incomplete intestinal rotation.[1],[3],[7],[8] The disease predominantly affects female patients of 40–60 years. Pathophysiologically, there are 3 types; Type 1 – cecal volvulus develops from clockwise axial torsion or twisting of the cecum around its mesentery, including the ascending colon and terminal ileum, Type II – loop volvulus develops from a counter clockwise axial torsion of the cecum around its mesentery, including the ascending colon and terminal ileum, and Type III – cecal bascule involves the upward folding of the cecum rather than axial twisting.[4],[9] The first 2 types represent 80% of cases.[4] All the three types require a mobile cecum and ascending colon, whether congenital or acquired.[10],[11] A cecal volvulus typically occurs in patients who have inherently increased cecal mobility, hypothesized to result from a congenital failure of the fusion of the ascending colon mesentery and the posterior parietal peritoneum.[5],[11] Acquired anatomic abnormalities, such as surgical adhesions, can also contribute to the development of a cecal volvulus. Clinical settings that have been associated with cecal volvulus include pregnancy,[10] colonic atony,[4] colonoscopy,[12] Hirschsprung's disease, and mobile cecum syndrome. The clinical symptoms of cecal volvulus are similar to those of blockage of the small intestine. Patients exhibit symptoms consistent with bowel obstruction, including abdominal pain, distension, constipation, obstipation, and vomiting.[8] Radiologically, plain X-rays, CT scan, and contrast studies with water-soluble substance can diagnose the case. CT confirms the diagnosis in 90% of cases. Surgery is the principle treatment in the form of right hemicolectomy or limited resection like in our case, with the restoration of bowel continuity. Cecopexy with appendectomy could be done if the patient's condition does not allow resection.[10],[13],[14] Laparoscopy could be used.[15] Approval of the ethical board of the hospital and informed consent from the patient were taken.

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Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Katoh T, Shigemori T, Fukaya R, Suzuki H. Cecal volvulus: Report of a case and review of Japanese literature. World J Gastroenterol 2009;15:2547-9.  Back to cited text no. 1
    
2.
Pousada L. Cecal bascule: An overlooked diagnosis in the elderly. J Am Geriatr Soc 1992;40:65-7.  Back to cited text no. 2
    
3.
Consorti ET, Liu TH. Diagnosis and treatment of caecal volvulus. Postgrad Med J 2005;81:772-6.  Back to cited text no. 3
    
4.
Delabrousse E, Sarliève P, Sailley N, Aubry S, Kastler BA. Cecal volvulus: CT findings and correlation with pathophysiology. Emerg Radiol 2007;14:411-5.  Back to cited text no. 4
    
5.
Lee SY, Bhaduri M. Cecal volvulus. CMAJ 2013;185:684.  Back to cited text no. 5
    
6.
Gingold D, Murrell Z. Management of colonic volvulus. Clin Colon Rectal Surg 2012;25:236-44.  Back to cited text no. 6
    
7.
Peterson CM, Anderson JS, Hara AK, Carenza JW, Menias CO. Volvulus of the gastrointestinal tract: Appearances at multimodality imaging. Radiographics 2009;29:1281-93.  Back to cited text no. 7
    
8.
Rakinic J. Colonic volvulus. In: Beck DE, Roberts PL, Nasseri Y, Senagore AJ, Stamos MJ Saclarides TJ, et al., editors. The ASCRS Textbook of Colon and Rectal Surgery. 2nd ed. New York: Springer; 2011. p. 395.  Back to cited text no. 8
    
9.
Ramsingh J, Hodnett R, Coyle T, Al-Ani A. Bascule caecal volvulus: A rare cause of intestinal obstruction. J Surg Case Rep 2014;2014. pii: Rju025.  Back to cited text no. 9
    
10.
Yee LF. Colonic Volvulus. American Society of Colon and Rectal Surgeons (ASCRS). Available from: http://www.fascrs.org/physicians/education/core_subjects/2006/colonic_volvulus/. [Last accessed on 2012 Oct 25].  Back to cited text no. 10
    
11.
Husain K, Fitzgerald P, Lau G. Cecal volvulus in the Cornelia de Lange syndrome. J Pediatr Surg 1994;29:1245-7.  Back to cited text no. 11
    
12.
Gupta S, Gupta SK. Acute caecal volvulus: Report of 22 cases and review of literature. Ital J Gastroenterol 1993;25:380-4.  Back to cited text no. 12
    
13.
Madiba TE, Thomson SR. The management of cecal volvulus. Dis Colon Rectum 2002;45:264-7.  Back to cited text no. 13
    
14.
Rabinovici R, Simansky DA, Kaplan O, Mavor E, Manny J. Cecal volvulus. Dis Colon Rectum 1990;33:765-9.  Back to cited text no. 14
    
15.
Baldarelli M, De Sanctis A, Sarnari J, Nisi M, Rimini M, Guerrieri M. Laparoscopic cecopexy for cecal volvulus after laparoscopy. Case report and a review of the literature. Minerva Chir 2007;62:201-4.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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