Caecopexy as management for caecal volvulus: An evidence-based case report

INTRODUCTION AND IMPORTANCE

The incidence of caecal volvulus (CV) reaches 2.8-7.1 per million per year. CV is a surgical emergency that must be treated immediately because the mortality rate can reach 30 %, and the recurrence rate is 40 %. This study showed a case illustration of caecal volvulus with evidence-based recommendations for indications and management of caecopexy based on postoperative outcomes.

CASE PRESENTATION

33-Year-old male came with chief complaints of persistent acute abdominal pain one day before hospital admission. Pain is felt suddenly throughout the abdomen. On physical examination, palpable pain in the entire abdomen is obtained, accompanied by the muscular defence with increased bowel sounds. The laboratory only showed increased white blood cells. Abdominal computed tomography (CT) with contrast showed closed-loop obstruction (CLO) signs.

CLINICAL DISCUSSION

Caecopexy technique use is supported in a case series because it can be done safely, quickly, and without the need to open intestinal segments. Based on previous researches, there were none to low rate of morbidity, mortality, and recurrence. In this patient, caecopexy was carried out and showed good output with no complications.

CONCLUSION

Caecopexy is a safe, simple, and less invasive procedure. The advantages of the caecopexy technique are low morbidity, mortality, and recurrence. The patient's outcome in this illustration is consistent with other literature. Thus it can be used as evidence-based recommendations in the management of the next case of caecal volvulus.

Caecal volvulus in an adult with an incomplete common mesentery: A case report

INTRODUCTION AND IMPORTANCE

A common mesentery is defined by the persistence of an embryonic anatomical arrangement secondary to an anomaly of rotation of the primary umbilical loop. Caecal volvulus is a rare cause of intestinal obstruction, which account for 1 to 1.5 % of all intestinal obstructions. A combination of both, intestinal mal rotation and caecal volvulus is rare.

CASE PRESENTATION

We report this rare entity in a 50 year old male with no history of abdominal surgery who was admitted for an acute intestinal obstruction. Clinical examination found a non-complicated right inguinal hernia. Radiological assessment showed signs of an incomplete common mesentery and an important small bowl distention with a transitional zone near the profound inguinal ring. Emergency surgery was performed. Surgical exploration didn't find signs of strangulation in the inguinal hernia which motivated midline laparotomy. We discovered a caecal volvulus with an incomplete common mesentery and ischemic lesions in the caecum. Ileocaecal resection was performed with ileocolostomy.

DISCUSSION

Common mesentery can be complete or incomplete. It is often well tolerated in adulthood. This intestinal malrotation can sometimes cause serious complications such as volvulus. Their association is rare. Radiology can be very helpful in leading to the diagnosis, but the diagnostic process should not delay surgical intervention which is the basis of the treatment.

CONCLUSION

Caecal volvulus is a serious complication of intestinal malrotation. This association is rare in adulthood and symptoms are not specific. Emergency surgery is necessary.

Caecal bascule - A variant of caecal volvulus: Review of diagnostic challenges and approaches

Caecal volvulus is a rare cause of intestinal obstruction, of which the caecal bascule is the most uncommonly encountered subtype. Definitive radiological diagnosis of a caecal bascule can be challenging. Lack of familiarity with this rare condition can contribute to delayed diagnosis and treatment, which may result in unnecessary morbidity. This article highlights the case of a patient who presented with a diagnostic challenge, and also discusses the pathogenesis and diagnostic features of caecal bascules. Various options in the surgical management of caecal bascules are reviewed, including the feasibility of laparoscopic-assisted approaches in the emergency setting.

A rare association of caecal volvulus and intestinal malrotation causing an acute abdomen: Case report

Introduction

and importance: Caecal volvulus represents 30% of colonic volvulus. It happens due to torsion or hyperflexion of a hypermobile caecum. Usually it is secondary to an axial rotation of the caecum and the ileum around the mesentery. On the other hand Intestinal malrotation occurs due to incomplete or faulty rotation and fixation of the gut during fetal life. The occurrence of these two anomalies together is scarse which makes this case report interesting.

Case presentation

A 75 year old man with medical history of terminal kidney failure, presented to the emergency room with an intestinal obstruction syndrome. On examination the patient had a distended abdomen with tenderness in the left upper quadrant. Biology found an important biological inflammatory syndrome with hyperleukocytosis and elevated CRP. Plain X-ray of the abdomen in erect posture showed an air fluid colonic level in the left hypochondrium. CT scan showed signs of caecal volvulus with intestinal malrotation. A brief reanimation and nasogastric aspiration couldn't solve the problem therefore emergency laparotomy was needed ileocaecal resection was performed associated with LADD's procedure in order to treat both anomalies and prevent further gut volvulus.

Clinical discussion

Despite it's rareness, caecul volvulus represents the second cause of large bowel volvulus just behind sigmoid volvulus. Intestinal malrotation in adults subjects is estimated to occur in 0.2–0.5%.The uniqueness of our case is that these two anomalies were associated in such a way that it made both the diagnosis and the therapy even more difficult. Abdominal CT has become mandatory for pre-operative diagnosis of intestinal volvulus. Surgery is the gold standard treatment for caecal volvulus. The usual options are manual detorsion, carcopexy, caecostomy and colectomy.

Conclusion

This case reports a rare association of a caecum volvulus with intestinal malrotation that emphasis the place of modern technologies such as CT scan in order to achieve correct preoperative diagnosis. We also describe our approach to this uncommon surgical emergency in order to provide an efficient treatement.

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Caecal volvulus associated with intestinal malrotation is rare.

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CT scan is mandatory for preoperative diagnosis of caecal volvulus.

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Surgery is the only permanent solution.

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Association of procedures for the caecal volvulus and the intestinal malrotation is the only prevention from recurrence.

Case-report: A rare cause of intestinal obstruction in late pregnancy

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Caecal volvulus represents a rare and often life-threatening cause of intestinal obstruction, with associated high mortality rates.

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Diagnosis and early intervention remain a challenge, as patients may only present with vague nonspecific symptoms.

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More classical symptoms of volvulus eventually occur, usually secondary to obstruction or ischaemia.

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Early diagnosis and intervention are of paramount importance.

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We advise clinicians to remember this diagnosis, as a potential cause of abdominal pain and obstruction; especially in those with risk factors.

Introduction

Caecal volvulus represents a rare and often life-threatening cause of intestinal obstruction. Diagnosis and management of caecal volvulus remains a clinical challenge, since those presenting with symptoms can have vague nonspecific presentations. Symptoms eventually occur, usually secondary to obstruction or ischaemia. This case report will discuss the presentation, investigation and management options available.

Presentation

A 31-year-old multigravida, at 38 weeks and 6 days gestation; presented to hospital with a 2-day history of diffuse abdominal pain and distension. Initial examination was unremarkable aside from mild epigastric tenderness. Raised inflammatory markers and concerns for foetal health resulted in an emergency caesarean section. Symptoms however worsened and the patient underwent colonoscopy and computerised tomography (CT) of the abdomen and pelvis with contrast; showing caecal volvulus. The patient was taken to the operating theatres for an emergency right hemicolectomy with formation of end ileostomy. Intra-operatively, areas of necrosis were noted within the caecum suggestive of impending perforation. The patient recovered well post reversal of end ileostomy, with no complications to date.

Discussion

Caecal volvulus represents a rare, but potentially fatal cause of intestinal obstruction and ischaemia. High mortality rates are attributed to delayed diagnosis and treatment. Patients may initially present with vague symptoms, which rapidly progress with the development of ischaemia. Multiple management modalities exist. Central to prognosis is early diagnosis.

Conclusion

Early diagnosis and intervention are paramount. Imaging via abdominal x-rays and CT are of particular importance. Surgical management is widely reported as the mainstay of treatment. We advise clinicians to remember this rare diagnosis, as a potential cause of abdominal pain and intestinal obstruction; especially in those with predisposing risk factors.

[Elective laparoscopic right colectomy for caecal volvulus: case report and literature review]

BACKGROUND

Caecal volvulus is an uncommon cause of intestinal obstruction. Its clinical presentation is non-specific, with the diagnosis usually confirmed by barium enema and abdominal computed tomography. Treatment depends on many factors, and minimally invasive approaches are becoming the treatment of choice.

CLINIC CASE

A 54 years old female, admitted to the Emergency Department with clinical symptoms of intestinal obstruction. On physical examination she had a palpable, firm, and tympanitic mass in the right abdomen, with peritoneal irritation. The radiographs of the abdomen, barium enema and abdominal computed tomography showed caecal volvulus. As she showed a full remission after the barium enema, with no clinical or biochemical data of systemic inflammatory response syndrome or peritoneal irritation, she was discharged to her home. Two weeks later, a laparoscopic right hemicolectomy was performed with an ileo-transverse extracorporeal anastomosis. Her progress was satisfactory, and she was discharged 4 days after surgery due to improvement.

CONCLUSION

Caecal volvulus is a rare cause of intestinal obstruction, with high mortality rates, and is caused by excessive mobility of the caecum. Its incidence is increasing. Treatment depends on many factors. Early non-surgical untwisting, followed by an elective laparoscopic surgical procedure offers several advantages and reduces mortality.

[Caecal bascule, an unusual cause of intestinal obstruction]

BACKGROUND

Caecal bascule is an infrequent type of caecal volvulus. It appears when the caecum folds upon itself, causing an intestinal obstruction. It is usually diagnosed using imaging techniques or intra-operatively. A constrictive band related to previous abdominal surgery is frequently present, and acts as an inflexion point that results in a closed loop obstruction of the ascending colon. It has been reported in young women and in elderly hospitalised patients. The aim of this report is to describe the clinical features, diagnostic difficulties, and management strategies of this unusual entity.

CLINICAL CASE

An 83-year-old male with concurrent acute neurological illness presented with history of intestinal obstruction. Because of a previous right nephrectomy, postoperative adhesions were suspected and conservative treatment initiated. As no improvement was seen, a computed tomography scan was obtained. Abdominal tomography showed an intestinal obstruction and a caecal bascule with vascular compromise. A right colectomy was performed.

CONCLUSIONS

Caecal bascule is a rare cause of intestinal obstruction. The suspicion should be heightened when caecal ectopic dilation is present. Computed tomography scan is the preferred imaging technique, especially for ill patients. Right colectomy and primary anastomosis is the most appropriate surgical technique. Awareness of this entity can prevent the high morbidity and mortality rates of this condition.

Caecal volvulus in an adolescent African male: a case report and brief review of the literature

Caecal volvulus is an infrequent clinical condition caused by an axial twist of ascending colon, caecum and terminal ileum around the mesenteric pedicle. This article presents the case of a 16-year old African male from Kenya who presented to the emergency department with acute onset right sided lower abdominal pain diagnosed intra-operatively as caecal volvulus. The rare nature of the condition, the need for a high index of suspicion and surgical management are highlighted.

Colonic tumour precipitating caecal volvulus within a diaphragmatic hernia

An 85-year-old woman presented with sudden onset of generalised abdominal pain and absolute constipation for 4 d. On examination she had a distended abdomen. Plain abdominal radiograph revealed a gas filled viscous within the left upper quadrant. Subsequent computed tomography suggested caecal volvulus herniated through a left diaphragmatic hernia. The patient underwent reduction of the internal hernia, right hemicolectomy and mesh repair of the diaphragmatic hernia. Postoperative recovery was uneventful. Histology revealed a Dukes’ A colonic cancer within the caecum. Herniation of caecal volvulus through a diaphragmatic hernia is a very rare condition and may have been precipitated by the colonic tumour.