- Richard A Hodin, MD
Richard A Hodin, MD
- Professor of Surgery
- Harvard Medical School
A cecal volvulus is the rotation or torsion of a mobile cecum and ascending colon, which causes approximately 1 to 3 percent of all large bowel obstructions [1-3]. If untreated, cecal volvulus can progress to bowel ischemia, necrosis, or perforation [4-8].
The clinical manifestations, diagnosis, and management of cecal volvulus are discussed here. Other causes of large bowel obstruction are discussed elsewhere. (See "Overview of mechanical colorectal obstruction" and "Sigmoid volvulus".)
Although volvulus can occur at other sites of the alimentary tract, including the stomach, gallbladder, and small bowel, they most commonly occur in the colon . The cecum (10 to 52 percent) and sigmoid colon (43 to 71 percent) are the two most common sites of colonic volvulus [7,10-14]. Other types of gastrointestinal volvuli, such as sigmoid volvulus or gastric volvulus, are discussed in detail elsewhere. (See "Sigmoid volvulus" and "Gastric volvulus in adults".)
In an epidemiologic study, 63,749 cases of colonic obstruction were admitted in the United States from 2002 to 2010 . The incidence of cecal volvulus increased by 5.53 percent per year, whereas the incidence of sigmoid volvulus remained stable. Sigmoid volvulus was more common in older adult males >70 years old, African Americans, and patients with diabetes and neuropsychiatric disorders; cecal volvulus was more prevalent in younger females.
In other studies, the incidence of cecal volvulus ranged from 2.8 to 7.1 per million people per year [4,6].
- Rakinic J. Colonic volvulus. In: The ASCRS textbook of colon and rectal surgery, 2nd, Beck DE, Roberts PL, Saclarides TJ, et al (Eds), Springer, New York 2011. p.395.
- Lee SY, Bhaduri M. Cecal volvulus. CMAJ 2013; 185:684.
- Baldarelli M, De Sanctis A, Sarnari J, et al. Laparoscopic cecopexy for cecal volvulus after laparoscopy. Case report and a review of the literature. Minerva Chir 2007; 62:201.
- Katoh T, Shigemori T, Fukaya R, Suzuki H. Cecal volvulus: report of a case and review of Japanese literature. World J Gastroenterol 2009; 15:2547.
- Pousada L. Cecal bascule: an overlooked diagnosis in the elderly. J Am Geriatr Soc 1992; 40:65.
- Consorti ET, Liu TH. Diagnosis and treatment of caecal volvulus. Postgrad Med J 2005; 81:772.
- Delabrousse E, Sarliève P, Sailley N, et al. Cecal volvulus: CT findings and correlation with pathophysiology. Emerg Radiol 2007; 14:411.
- Perret RS, Kunberger LE. Case 4: Cecal volvulus. AJR Am J Roentgenol 1998; 171:855, 859, 860.
- Peterson CM, Anderson JS, Hara AK, et al. Volvulus of the gastrointestinal tract: appearances at multimodality imaging. Radiographics 2009; 29:1281.
- Abita T, Lachachi F, Durand-Fontanier S, et al. [Cecal volvulus]. J Chir (Paris) 2005; 142:220.
- Ballantyne GH, Brandner MD, Beart RW Jr, Ilstrup DM. Volvulus of the colon. Incidence and mortality. Ann Surg 1985; 202:83.
- Hiltunen KM, Syrjä H, Matikainen M. Colonic volvulus. Diagnosis and results of treatment in 82 patients. Eur J Surg 1992; 158:607.
- Gingold D, Murrell Z. Management of colonic volvulus. Clin Colon Rectal Surg 2012; 25:236.
- Halabi WJ, Jafari MD, Kang CY, et al. Colonic volvulus in the United States: trends, outcomes, and predictors of mortality. Ann Surg 2014; 259:293.
- Husain K, Fitzgerald P, Lau G. Cecal volvulus in the Cornelia de Lange syndrome. J Pediatr Surg 1994; 29:1245.
- DONHAUSER JL, ATWELL S. Volvulus of the cecum with a review of 100 cases in the literature and a report of six new cases. Arch Surg 1949; 58:129.
- Rogers RL, Harford FJ. Mobile cecum syndrome. Dis Colon Rectum 1984; 27:399.
- John H, Gyr T, Giudici G, et al. Cecal volvulus in pregnancy. Case report and review of literature. Arch Gynecol Obstet 1996; 258:161.
- Radin DR, Halls JM. Cecal volvulus: a complication of colonoscopy. Gastrointest Radiol 1986; 11:110.
- Sarioğlu A, Tanyel FC, Büyükpamukçu N, Hiçsönmez A. Colonic volvulus: a rare presentation of Hirschsprung's disease. J Pediatr Surg 1997; 32:117.
- Habre J, Sautot-Vial N, Marcotte C, Benchimol D. Caecal volvulus. Am J Surg 2008; 196:e48.
- Swenson BR, Kwaan MR, Burkart NE, et al. Colonic volvulus: presentation and management in metropolitan Minnesota, United States. Dis Colon Rectum 2012; 55:444.
- Hashimoto Y, Shigemoto S, Nakashima A, et al. Successful preoperative diagnosis of a rare bowel obstruction: cecal volvulus. J Gastrointest Surg 2008; 12:202.
- Anderson JR, Welch GH. Acute volvulus of the right colon: an analysis of 69 patients. World J Surg 1986; 10:336.
- Rosenblat JM, Rozenblit AM, Wolf EL, et al. Findings of cecal volvulus at CT. Radiology 2010; 256:169.
- Moore CJ, Corl FM, Fishman EK. CT of cecal volvulus: unraveling the image. AJR Am J Roentgenol 2001; 177:95.
- Rabinovici R, Simansky DA, Kaplan O, et al. Cecal volvulus. Dis Colon Rectum 1990; 33:765.
- Gupta S, Gupta SK. Acute caecal volvulus: report of 22 cases and review of literature. Ital J Gastroenterol 1993; 25:380.
- Frank AJ, Goffner LB, Fruauff AA, Losada RA. Cecal volvulus: the CT whirl sign. Abdom Imaging 1993; 18:288.
- Madiba TE, Thomson SR. The management of cecal volvulus. Dis Colon Rectum 2002; 45:264.
- Mellor MF, Drake DG. Colonic volvulus in children: value of barium enema for diagnosis and treatment in 14 children. AJR Am J Roentgenol 1994; 162:1157.
- Schwab FJ, Glick SN, Teplick SK. Reduction of cecal volvulus by multiple barium enemas. Gastrointest Radiol 1985; 10:185.
- Tejler G, Jiborn H. Volvulus of the cecum. Report of 26 cases and review of the literature. Dis Colon Rectum 1988; 31:445.
- Majeski J. Operative therapy for cecal volvulus combining resection with colopexy. Am J Surg 2005; 189:211.
- Jones RG, Wayne EJ, Kehdy FJ. Laparoscopic detorsion and cecopexy for treatment of cecal volvulus. Am Surg 2012; 78:E251.
- Shoop SA, Sackier JM. Laparoscopic cecopexy for cecal volvulus. Case report and a review of the literature. Surg Endosc 1993; 7:450.
- CLINICAL MANIFESTATIONS
- Patient presentation
- Physical examination
- Laboratory studies
- Diagnostic evaluation
- DIFFERENTIAL DIAGNOSIS
- IMAGING STUDIES
- Upright abdominal plain films
- CT scan
- Contrast studies
- Patients without bowel compromise
- - Stable patients without bowel compromise
- - Unstable patients without bowel compromise
- Patients with bowel compromise
- - Stable patients with bowel compromise
- - Unstable patients with bowel compromise
- Open versus laparoscopic surgery
- SUMMARY AND RECOMMENDATIONS