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Cecal volvulus

INTRODUCTION

A cecal volvulus is the rotation or torsion of a flexible cecum and ascending colon, frequently progressing to bowel obstruction, ischemia, necrosis, and perforation [1-5]. Volvuli can occur at other sites in the alimentary tract, including the sigmoid colon, stomach, gallbladder, splenic flexure, and small bowel [6,7].

EPIDEMIOLOGY

The incidence of cecal volvulus ranges from 2.8 to 7.1 per million people per year [1,3]. Cecal volvulus accounts for approximately 1 to 3 percent of all large intestinal obstructions [8-10]. Depending upon the series and age of the patients, cecal volvulus represents 10 to 52 percent of all cases of colonic volvuli [4,11-15]. For example, a retrospective review of 137 patients with a colonic volvulus identified the following segments involved [12]:

  • Cecum – 52 percent
  • Sigmoid – 43 percent
  • Transverse colon – 3 percent
  • Splenic flexure – 2 percent

Patients with a cecal volvulus are young, with a mean age varying from 33 years in India to 53 years in Western countries [16,17]. In contrast, sigmoid volvulus usually occurs in elderly subjects with chronic constipation or distal colon obstruction. The patients are often institutionalized and debilitated with neurologic and psychiatric conditions, such as Parkinson disease and schizophrenia. (See "Sigmoid volvulus".)

PATHOPHYSIOLOGY

There are three types of cecal volvuli [1-5]:

            

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Literature review current through: Apr 2013. | This topic last updated: Nov 19, 2012.
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References
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