Caecal volvulus in a 35-year-old man: a case report

Abstract

Caecal volvulus is a rare cause of mechanical bowel obstruction (1-1.5%) that carries a high mortality rate if diagnosis or surgical intervention is delayed. We report a 35-year-old man who presented with acute colicky abdominal pain, vomiting, and constipation for the past 18 hours. A plain abdominal X-ray showed distended large bowel loops with two large well-defined air-fluid levels superimposed on each other, suggestive of caecal volvulus. The patient underwent emergency laparotomy, and the intraoperative finding confirmed the diagnosis of gangrenous extended caecal volvulus, which involves the terminal ileum, cecum, and the whole of the ascending colon. A right hemicolectomy was performed, and bowel continuity was restored by primary ileotransverse anastomosis. The patient recovered without complications and was discharged on postoperative day 6. In conclusion, caecal volvulus is a rare cause of adult intestinal obstruction. Early diagnosis and surgical intervention can prevent perforation and reduce morbidity related to volvulus perforation.

Keywords: Intestinal obstruction; adult; caecal volvulus; case report; colicky abdominal pain.

Figure 1

plain abdominal radiography showing two large well-defined air-fluid levels approximately 15 cm in width superimposed on each other located at the left upper quadrant of the abdomen (arrows), with minimal gas seen at the distal bowel loops; A) erect view; B) supine view

Figure 2

intraoperative photos showing; A) darkly colored cecum with previous appendectomy scar; B) gangrenous caecal volvulus; C) the excised terminal ileum, cecum, and whole ascending colon