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Case Reports
. 2019 Oct 31:48:69-72.
doi: 10.1016/j.amsu.2019.10.021. eCollection 2019 Dec.

Acute cecal volvulus: A diagnostic and therapeutic challenge in emergency: A case report

Abdoul Aliou Zabeirou  1 , Houssam Belghali  1 , Tarek Souiki  1   2 , Karim Ibn Majdoub  1   2 , Imane Toughrai  1   2 , Khalid Mazaz  1   2
Affiliations
Case Reports

Acute cecal volvulus: A diagnostic and therapeutic challenge in emergency: A case report

Abdoul Aliou Zabeirou et al. Ann Med Surg (Lond). .

Abstract

Introduction: Cecal volvulus is an uncommon cause of intestinal obstruction due to an axial twist of the caecum, ascending colon and terminal ileum around the mesenteric pedicle. It is responsible for 1%-1.5 of all intestinal obstructions in adult. The clinical signs may be highly variables and can be responsible of delays in diagnostic and treatment. The delay in diagnosis leads to intestinal necrosis or perforation. The mortality ranges from 10 to 40% depending on the presence of a viable or gangrenous intestine.

Presentation of case: A 64 year old woman admitted the emergency department for acute bowel obstruction. Clinical examination found typically acute bowel obstruction signs. Plain radiography showed dilated gas-filled segment of the colon in the left side of abdomen and volvulus of cecum was suspected. Enhanced abdominal CT scan confirmed the diagnosis. Emergency exploratory laparotomy was performed and confirmed the cecal volvulus. A manual untwisting of volvulus and a Caecopexy were performed. The patient subsequently recovered uneventfully and was discharged on postoperative day 3.

Discussion: The management of cecal volvulus requires prompt (emergency) diagnosis and prompt surgical intervention. Any delay in diagnosis may lead to intestinal necrosis or perforation and worsening the prognosis in patients who are generally elderly. Several authors reported a high mortality rate of cecal volvulus due to delay to diagnosis and surgical intervention.

Conclusion: The low incidence of this condition needs a high index of suspicion and emergency surgical management. Despite significant progress in medical imaging, the preoperative diagnosis of cecal volvulus is very difficult. As a result, the treatment is often delayed.

Keywords: Bowel obstruction; Caecopexy; Cecal volvulus; Manual untwisting.

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Conflict of interest statement

All authors declare that they have no any conflicts of interest.

Figures

Fig. 1
Fig. 1
A: Plain radiography revealed a markedly air-distended bowel in the left abdomen, B: Abdominal CT scan showing coffee bean sign (red arrow) and whirl sign (blue arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Fig. 2
Fig. 2
Intraoperative view showing; A: empty right iliac fossa; B: distended caecum occupied the left upper quadrant of the abdomen (arrow); C: cecal volvulus with the point of twisting for the caecum and terminal ileum being visible (arrow).
Fig. 3
Fig. 3
Intraoperative view showing; A: unfixed Cecum to the retroperitoneum after manual untwisting. B: Appendix (arrow).
See this image and copyright information in PMC

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