Cecal Volvulus Diagnosis and Management
Summary
Cecal volvulus is an uncommon but potentially life-threatening form of large-bowel obstruction caused by axial twisting or folding of a mobile caecum and ascending colon around its mesenteric pedicle. Accounting for roughly 1–1.5% of adult intestinal obstructions, the condition presents with variable symptoms such as acute abdominal pain, distension, constipation and vomiting, often leading to diagnostic delay. Clinical examination alone is insufficient, and plain abdominal radiography may be suggestive but not definitive. Contrast-enhanced computed tomography has emerged as the gold standard, revealing characteristic signs including the ‘whirl sign’, focal caecal dilatation and absence of normal colonic haustra. Management is invariably surgical: options range from detorsion with caecopexy in viable bowel to resection and primary anastomosis or stoma formation when ischaemia or gangrene is present. Minimally invasive approaches, such as laparoscopic-assisted detorsion and resection, have been introduced to reduce morbidity. Prompt diagnosis and timely intervention are essential to avoid perforation, peritonitis and high mortality rates that may exceed 30% in delayed cases.
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Cecal Volvulus Diagnosis and Management publication trend
The graph below shows the total number of articles in cecal volvulus diagnosis and management across all publications each year (not limited to Nature Index journals).
Technical terms
Volvulus: Twisting of a bowel segment around its mesenteric attachment, causing obstruction and possible ischaemia.
Caecopexy: Surgical fixation of the caecum to the posterior abdominal wall to prevent recurrent torsion.
Right hemicolectomy: Resection of the caecum, ascending colon and proximal transverse colon, followed by re-establishment of bowel continuity.
Whirl sign: Radiological finding on CT representing twisted mesenteric vessels and bowel loops.
Indocyanine green fluorescence angiography: Intraoperative technique using a fluorescent dye to visualise and assess tissue perfusion in real time.
References
- Laparoscopic assisted right hemicolectomy for caecal volvulus. World Journal of Emergency Surgery (2008).
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