What is the treatment for cecal volvulus?

Treatment of Cecal Volvulus

For cecal volvulus, right hemicolectomy is the definitive treatment as endoscopy has no role, and surgery is the only option. 1

Diagnosis and Initial Assessment

• Cecal volvulus occurs when an abnormally mobile cecum twists on its own axis, potentially leading to closed-loop obstruction, intestinal ischemia, and perforation 2, 3
• Diagnosis should be confirmed through plain abdominal radiographs as first line, followed by abdominal CT (gold standard) showing the "whirl sign" of twisted colon and mesentery 1
• Cecal volvulus accounts for approximately 30% of all colonic volvulus cases and 1-1.5% of all intestinal obstructions in adults 2, 4

Treatment Algorithm

Emergency Surgical Management

• Unlike sigmoid volvulus, endoscopic decompression has no role in cecal volvulus, and surgery is the only treatment option 1
• Right hemicolectomy is the procedure of choice for cecal volvulus 1, 5
• If the patient presents with septic shock, bowel ischemia, or perforation, immediate surgical intervention is mandatory 1
• Mortality ranges from 10-40% depending on whether the intestine is viable or gangrenous 2

Surgical Options Based on Bowel Viability

• For gangrenous or grossly distended thin-walled cecum: Resection is mandatory 5
• For viable bowel: Right hemicolectomy with primary anastomosis is preferred over cecopexy or cecostomy 5
• Alternative procedures like cecopexy (fixing the cecum to the abdominal wall) and cecostomy are considered less effective and associated with higher morbidity compared to resection and anastomosis 5

Laparoscopic Approach

• Laparoscopic surgery may be a viable option in selected cases, even in patients with obstruction 6
• However, the benefits of laparoscopic approach in emergency settings remain unclear compared to open approach 1

Important Considerations

• Early recognition and prompt treatment are crucial as delay in diagnosis can lead to intestinal necrosis or perforation 2
• The mortality rate increases significantly if gangrene develops 5
• Recurrence is possible after cecopexy alone, particularly in cases with underlying anatomical abnormalities such as intestinal malrotation 6
• Patients who have undergone successful treatment should be monitored for potential complications and recurrence 6

Risk Factors

• Anatomical predisposition such as abnormal cecal mobility is a key factor 2
• Chronic constipation, high-fiber diet, and frequent use of laxatives may contribute to development of colonic volvulus 1
• Dolicho-colon (elongated colon on a narrow mesenteric base) is a predisposing factor 7