Caecal Volvulus: An Uncommon Disease with Common Presentation
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 19, Issue 2
Abstract
Caecal volvulus is rare cause of intestinal obstruction. However, it is imperative to know the predisposing factors to make an early diagnosis of cecal volvulus and would be able to decrease morbidity and mortality. Here, we report a case of caecal volvulus in a susceptible patient with typical features of caecal volvulus with chronic obstruction of sigmoid colon due to adhesionCeacal volvulus was first noted by Hildanus in the 16th century and later reviewed by Rokitansky in 1837. It is the second most common site for volvulus of intestine. The incidence of cecal volvulus is reported to range from 2.8 to 7.1 per million people per year [1]. It accounts for 1 to 1.5% of all the adult intestinal obstructions and 25 to 40% of all volvulus involving the colon. It is axial twisting that involves the caecum, terminal ileum and ascending colon. It is due to incomplete embryological rotation of the bowel or improper developmental fusion is explanation for development of caecal volvulus. There are two prerequisites for caecal volvulus to occur: a segment of mobile caecum and ascending colon and a point of fixation about which torsion may occur [2]. In addition to the prerequisite of a freely mobile caecum, several additional predisposing factors have been implicated in the genesis of caecal volvulus. These include concomitant acute medical problems, pregnancy, distal colonic obstruction, previous laparotomy, and gynaecological procedures [3] (Figure 1). It is reported to be associated with previous abdominal surgery in up to 68% of cases [4,3]. Appendicitis as a cause of caecal volvulus was first reported by Cochrane in 1929 followed by a few reports [5,6].The focal rounded air-filled cecum may present as a loop with haustral markings resembling a coffee bean; which appears as a dilated bowel loop with an inverted “U” shape converging at the site of torsion, and a thickened central radiopaque line composed by the walls of the two part of the colon that are adjacent to each other. Doppler USG may lead to make a definite diagnosis by showing twisted mesenteric vessels [11], and CT may be more diagnostic by demonstrating cecal distension, cecal apex in left upper quadrant, mesenteric whirl, ileocecal twist, and small bowel distension [12]. An important sign to look for is the “whirl sign” that consists of a whirlpool pattern of swirling structures including collapsed bowel loops, mesenteric fat and engorged ileocecal vessels (Figure 3). This finding, associated to a dislocated enlarged cecum, is acknowledged to be diagnostic of volvulus [9,13]. The treatment of caecal volvulus preferred surgical procedure for the treatment of patients with cecal volvulus is right hemicolectomy [7].
Authors and Affiliations
Muhammed AS, Aye M, Harshad R
Keywords
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- EP ID EP620662
- DOI 10.26717/BJSTR.2019.19.003268
- Views 170
- Downloads 0
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