- 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].
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- 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