Christopher Gasink, MD; David A. Katzka, MD

Disclosures

October 04, 2004

Clinical Outcome and Discussion

A diagnosis of cecal volvulus was made. Because of continued pain, a diagnostic laparotomy was performed which revealed a dusky-appearing cecum with a cecal volvulus draped across an adhesive band crossing the ascending colon. The patient underwent a right hemicolectomy without complication. She recovered without difficulty.

Cecal volvulus accounts for approximately 40% to 50% of all colonic volvulus.[1] The average age at presentation is 53 years. Risk factors for cecal volvulus include congenital conditions, such as Hirschsprung's disease, as well as other congenital malformations that lead to increased cecal mobility. Acquired risk factors include surgical adhesions, pregnancy, colonoscopy, left colonic obstruction, increased gas production, high-fiber diet, and pseudo-obstruction. There is also a higher prevalence of cecal volvulus in older patients, particularly those with comorbid illness or who are institutionalized.[2]

The diagnosis of cecal volvulus is first based on findings on abdominal film, which may show the classic "kidney bean" sign -- the dilated cecum extending into the left upper quadrant. Abdominal films may also show typical signs of obstruction. The differential diagnosis includes cecal obstruction from other causes, such as adenocarcinoma of the colon or pseudo-obstruction. A cecal volvulus may also be confused with sigmoid volvulus because of the location of the dilated cecum on the left side of the abdomen. The diagnosis is suggested by findings on obstructive series in 46% of cases, and these findings are diagnostic in 17% of cases. Barium enema study shows a tapered edge at the site of obstruction; this is diagnostic in 88% of cases.[1,2]

The definitive treatment for cecal volvulus is surgical correction. Detorsion and cecopexy have the lowest rates of complications, mortality, and recurrence at 15%, 10%, and 13%, respectively. Cecostomy is associated with the highest rates of complications and volvulus recurrence (52% and 22%, respectively).[3,4]

Right hemicolectomy with primary anastomosis may also be performed, and with current surgical methodology, is the treatment of choice.[1] Patients with bowel ischemia should undergo a resection with a 2-stage procedure.

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