Recurrent cecocolic torsion: radiological diagnosis and treatment

Abstract

Recurrent cecocolic torsion may cause recurrent right lower abdominal pain and right-sided thrust dyspareunia. It is seldom considered in the differential diagnosis of pain in this region. The propensity of the cecocolon to torse is secondary to the double developmental defect of a mobile cecocolon compounded by an elongated and overrotated organ that can be eccentrically located in the abdomen. The torsion may result in recurrent obstructions with spontaneous resolutions, but it may proceed to an acute episode of obstruction and strangulation with a more profound morbidity and mortality rate. The diagnosis of recurrent cecocolic torsion is verified by a plain x-ray film of the abdomen, contrast enema, and computed tomography scan. The preferred treatment is outpatient laparoscopic cecocolopexy. Laparoscopic or classical open cecocolectomy and right hemicolectomy are reserved for more complex and morbid presentations.

Figure 1.

The cecum is at the right upper quadrant. Note staples from appendectomy.

Figure 2.

Figure 2. A redundant cecocolon above the iliac crest.

Figure 3.

Cecocolon deviated medially.

Figure 4.

Cecocolon over-rotated into the pelvis.

Figure 5.

Cecocolon over-rotated transversely across the midline in the lower abdomen.

Figure 6.

Cecocolon over-rotated transversely across the midline in the upper abdomen.

Figure 7.

Massively dilated cecocolon with air-contrast located at the upper abdomen in communication with a normal-sized ascending colon.

Figure 8.

CT scan demonstrating the massively dilated cecocolon with air-contrast located at the upper abdomen in communication with a normal-sized ascending colon. A verification of Figure 7.

Figure 9.

A rare CT scan depiction of the cystic configuration of recurrent cecocolic torsion.

Figure 10.

Laparoscopic picture of a freely mobile cecocolon.

Figure 11.

A mobile and redundant cecocolon at laparotomy, showing the site of the kink.

Figure 12.

A dilated, hypertrophic, thick-walled, hyperemic, and tumescent cecocolic segment at laparotomy.