Caecal Volvulus Presenting as an Obstructed Inguinal Hernia: A Case Report

Abstract

Caecal volvulus (CV) is an uncommon cause of large intestinal obstruction due to the axial torsion of the caecum, ascending colon, and terminal ileum. We describe the case of a 37-year-old man who presented with bilateral inguinal hernias (the left larger than the right), diffuse abdominal pain, vomiting, difficulty passing stool, and flatus that were comparable to those of an obstructed hernia. Imaging tests revealed a collapsed ascending colon, free fluid collection, and a significantly dilated proximal ileum. An urgent laparotomy showed a perforated, clockwise-twisted caecum that required a right hemicolectomy. Postoperatively, the patient had a good recovery. CV is uncommon, and its symptoms are vague, making diagnosis difficult. For an accurate diagnosis and prompt action, imaging tools and a high index of suspicion are essential. This case serves as a reminder of the significance of taking rare entities into consideration in developing a differential diagnosis of complex abdominal presentations and the necessity for a differential diagnostic approach to choose the most suitable surgical course of action.

Keywords: caecal volvulus; hand-sewn anastomosis; intestinal perforation; rare case of intestinal obstruction; right hemicolectomy.

Figure 1. Preoperative abdominal CT image of the patient in favour of caecal volvulus.

Gross dilatation of the caecum with a convergence of its two limbs was noted along with proximal dilatation of bowel loops. Mesenteric vessels are seen converging towards the dilated caecum with adjacent mesenteric fat stranding.

Figure 2. The phlegmon present in the right iliac fossa.

The blue arrow indicates the mass in the right iliac fossa with the overlying plastered omentum.

Figure 3. Caecum along with its mesocolon twisted clockwise around its base.

The green arrow indicates the twisted caecum with the adjacent ascending colon with the mesentery along its longitudinal axis.