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.

Cecal Volvulus: A Rare Cause of Intestinal Obstruction

“…Although abdominal radiography may show the features of an intestinal obstruction, including widespread small intestinal air-fluid levelsand/or distended cecum in the right abdomen, making the cecal volvulus diagnosis is difficult or impossible in most of the cases [2,3,6], as was in ours. Doppler USG may lead to make a definite diagnosis by showing twisted mesenteric vessels [6], and CT may be more diagnostic by demonstrating cecal distension, cecal apex in left upper quadrant, mesenteric whirl, ileocecal twist, and small bowel distension [4,7].…”

“…Many factors have been referred as correlated to cecal volvulus development, mainly anatomical predispositions such as incomplet intestinal rotation, and previous abdominal operations [1,3,6,7]. The disease predominantly affects female patients 40-60 years of age, as was in our case [6].…”

“…Abdominal pain, distension, naeusea, vomiting, and diarrhea or constipation are the main clinical features of cecal volvulus [1-3, 6, 7], but unfortunately clinical symptoms, signs, and routine laboratory tests are not spesific enough to lead to a prompt diagnosis [3]. Although abdominal radiography may show the features of an intestinal obstruction, including widespread small intestinal air-fluid levelsand/or distended cecum in the right abdomen, making the cecal volvulus diagnosis is difficult or impossible in most of the cases [2,3,6], as was in ours.…”

“…Although it generally present as a small bowel obstruction [2], clinical symptoms, signs, and routine laboratory tests arenot spesific to the disease [3], whileCT is more diagnostic [4]. Surgical intervention is the only treatment of cecal volvulus [1].…”

“…Surgical intervention is the only treatment of cecal volvulus [1]. The prognosis of the disease may be poor with a 0-40% mortality rate depending on the bowel viability or gangrene [1,3].…”