Rare synchronous caecal and sigmoid volvulus: management of two cases

Abstract

Colonic volvulus is one of leading causes of large bowel obstruction following colorectal cancer and diverticulitis, accounting for 5% of cases. Sigmoid volvulus is most common (75%) followed by volvulus of the caecum (15%), transverse colon (3%) and splenic flexure (2%). Synchronous volvulus of the caecum and sigmoid is very rare, with six reported cases in the literature to the best of our knowledge. We report two cases within 6 months. The key learning points include that classical radiological signs of both caecal and sigmoid volvulus may not be present, and that prompt, definitive management is necessary to prevent recurrence and morbidity.

Sigmoid volvulus and concomitant clinical entities

“…Any number of reports on synchronous or metachronous volvulus involving the sigmoid colon and cecum, [39,40] transverse colon, [41,42] small intestines, [43] or even stomach [44] were present in the literature. In such cases, mobile intestines generally arising from intestinal malrotation play an activate role in SV.…”

Vólvulo sincrónico de ciego y sigmoides: una causa rara de obstrucción intestinal

“…In our theoretical opinion, the high incidence of a congenital anatomical prerequisite, mobile cecum, may be responsible for this relatively high incidence of CV in the authors' practicing area. Similarly, although most likely due to the rarity of SCSV, the pathogenesis of this clinical entity is not clearly identified 1,2,4 , the togetherness of mobile cecum and dolichosigmoid, the last which is the presence of an elongated and dilated sigmoid colon as a well-known anatomical prerequisite for SV, may explain the probable pathogenesis of SCSV.…”