Cecal volvulus

Cecal Volvulus

Cecal volvulus is a medical condition characterized by the twisting of the cecum, the first part of the large intestine, which can lead to bowel obstruction. This condition is a type of volvulus, which refers to the twisting of any part of the intestine, causing obstruction and potentially leading to ischemia and necrosis if not promptly treated.

Pathophysiology

Cecal volvulus occurs when the cecum and ascending colon twist around their mesentery, the tissue that attaches the intestines to the posterior abdominal wall. This twisting can obstruct the lumen of the bowel, preventing the passage of intestinal contents, and can also compromise the blood supply to the affected segment of the intestine. If the blood supply is compromised, it can lead to ischemia and necrosis of the bowel tissue.

Causes

Several factors can predispose an individual to cecal volvulus, including:

• Congenital malrotation: Abnormal rotation of the intestines during fetal development can predispose to volvulus.
• Adhesions: Scar tissue from previous surgeries can create points of fixation that facilitate twisting.
• Chronic constipation: Can lead to increased pressure and mobility of the cecum.
• Pregnancy: The enlarging uterus can displace the cecum and contribute to volvulus.

Symptoms

The symptoms of cecal volvulus can vary but often include:

• Abdominal pain: Sudden onset of severe, crampy abdominal pain.
• Distension: Swelling of the abdomen due to trapped gas and fluid.
• Nausea and vomiting: Resulting from bowel obstruction.
• Constipation or obstipation: Inability to pass stool or gas.

Diagnosis

Diagnosis of cecal volvulus is typically made through a combination of clinical evaluation and imaging studies. Common diagnostic tools include:

• Abdominal X-ray: May show a "coffee bean" sign indicative of volvulus.
• CT scan: Provides detailed images and can confirm the diagnosis by showing the twisted bowel and any associated complications.
• Barium enema: Can sometimes be used to diagnose and potentially reduce the volvulus.

Treatment

The treatment of cecal volvulus often requires surgical intervention. Options include:

• Detorsion: Untwisting the volvulus, which may be attempted during surgery.
• Cecopexy: Surgical fixation of the cecum to prevent recurrence.
• Resection: Removal of the affected bowel segment if it is necrotic or if detorsion is not possible.

Prognosis

The prognosis for cecal volvulus depends on the timeliness of diagnosis and treatment. If treated promptly, the outcome is generally favorable. However, delayed treatment can lead to complications such as bowel necrosis, perforation, and peritonitis, which can significantly worsen the prognosis.

Also see

• Volvulus
• Intestinal obstruction
• Ischemic colitis
• Bowel resection