From the Guidelines
Cecal volvulus management requires prompt surgical intervention with right hemicolectomy as the primary treatment. The initial approach should include fluid resuscitation, correction of electrolyte abnormalities, and nasogastric tube decompression. Patients should receive broad-spectrum antibiotics, such as piperacillin-tazobactam or cefazolin plus metronidazole, to prevent infection.
Key Considerations
- The definitive treatment for cecal volvulus is surgical, with right hemicolectomy being the preferred approach due to lower recurrence rates compared to cecopexy, as indicated in the study on bowel obstruction 1.
- In unstable patients or those with gangrenous bowel, resection is mandatory.
- Cecopexy may be considered in high-risk surgical patients without evidence of bowel compromise.
- Colonoscopic detorsion is not recommended for cecal volvulus due to its ineffectiveness, as stated in the study on bowel obstruction 1.
Evaluation and Diagnosis
- Abdominal X-rays and CT scans are essential for diagnosis, with the CT scan being diagnostic in most cases, showing characteristic signs such as the "coffee bean" or "bird beak" sign.
- Evaluation should prioritize identifying signs of ischemia, necrosis, or perforation, which necessitate urgent surgical intervention.
Treatment Outcomes
- Prompt surgical intervention can significantly reduce morbidity, mortality, and improve quality of life for patients with cecal volvulus.
- Delayed treatment can lead to high mortality rates, emphasizing the importance of urgent intervention.
From the Research
Management of Cecal Volvulus
- Surgical management is required in almost every case of cecal volvulus, as the condition can lead to gangrenous bowel or loss of intestinal viability 2.
- The choice of surgical procedure depends on the clinical circumstances, with options including cecopexy, resection, and detorsion 2, 3.
- Laparoscopic cecopexy is a satisfactory choice of procedure in many settings, as it allows for the resection to be obviated, bowel need not be opened, and the operation can be performed relatively rapidly 2.
- Single-site laparoscopic right hemicolectomy is a less invasive technique that can be used to treat acute cecal volvulus, with satisfactory outcomes and cosmesis 4.
- Elective laparoscopic right colectomy can be performed for caecal volvulus, with the advantage of reducing mortality rates 5.
Evaluation of Cecal Volvulus
- Computed tomography (CT) is effective for diagnosing cecal volvulus, and can help identify the need for emergency surgery 6.
- Indocyanine green (ICG) fluorescence imaging can be used intraoperatively to confirm blood flow in the ileocecal area, and guide the decision to perform cecopexy or resection 6.
- Barium enema and abdominal computed tomography can be used to confirm the diagnosis of caecal volvulus, and guide the decision to perform surgery 5.
- Colonoscopic treatment can be attempted in some cases, but may not be successful, and emergency surgery may be necessary 6.