Is laparotomy the unavoidable step to diagnose caecal volvulus?

Abstract

Caecal volvulus is the axial twist of the caecum, ascending colon and terminal ileum around the mesenteric pedicle. This infrequently encountered clinical entity is responsible for 1-1.5% of all intestinal obstruction with a mortality of 10-40% depending on the presence of colon viability or intestinal gangrene. Many factors have been referred as correlated to caecal volvulus development, mainly anatomical predisposition and previous abdominal operations. Pre-operative diagnosis plays an important role in the management of such patients. Unfortunately, clinical signs, symptoms and laboratory tests are never specific enough to lead to a prompt diagnosis. Abdominal radiography and computed tomography may allow a diagnosis if typical signs are present. However, up to 30% of patients do not show these radiographic peculiarities, making the diagnosis difficult or impossible. Moreover, the low incidence of this disease is often responsible of a wrong or imprecise diagnosis, especially for radiologists who work with low volume of patients. We report a case of a patient with caecal volvulus, in which laparotomy was unavoidable to reach a diagnosis.

Figure 1

Huge caecal dilatation at the plain supine abdominal X-ray.

Figure 2

Plain supine abdominal X-ray with lateral view. Some air-fluid levels are evident.

Figure 3

CT showing the right dislocation of the mesenteric vessels. No whirl sign was detectable.