Acute cecal volvulus: A diagnostic and therapeutic challenge in emergency: A case report

INTRODUCTION: Cecal volvulus is an uncommon cause of intestinal obstruction due to an axial twist of the caecum, ascending colon and terminal ileum around the mesenteric pedicle. It is responsible for 1%-1.5 of all intestinal obstructions in adult. The clinical signs may be highly variables and can be responsible of delays in diagnostic and treatment. The delay in diagnosis leads to intestinal necrosis or perforation. The mortality ranges from 10 to 40% depending on the presence of a viable or gangrenous intestine. PRESENTATION OF CASE: A 64 year old woman admitted the emergency department for acute bowel obstruction. Clinical examination found typically acute bowel obstruction signs. Plain radiography showed dilated gas-filled segment of the colon in the left side of abdomen and volvulus of cecum was suspected. Enhanced abdominal CT scan confirmed the diagnosis. Emergency exploratory laparotomy was performed and confirmed the cecal volvulus. A manual untwisting of volvulus and a Caecopexy were performed. The patient subsequently recovered uneventfully and was discharged on postoperative day 3. DISCUSSION: The management of cecal volvulus requires prompt (emergency) diagnosis and prompt surgical intervention. Any delay in diagnosis may lead to intestinal necrosis or perforation and worsening the prognosis in patients who are generally elderly. Several authors reported a high mortality rate of cecal volvulus due to delay to diagnosis and surgical intervention. CONCLUSION: The low incidence of this condition needs a high index of suspicion and emergency surgical management. Despite significant progress in medical imaging, the preoperative diagnosis of cecal volvulus is very difficult. As a result, the treatment is often delayed.