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A D V E R T I S E M E N T
A D V E R T I S E M E N T
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Cecal volvulus involves twisting of a mobile cecum and adjacent terminal ilium, creating a closed loop. On plain film, the loop usually extends from lower right to upper left. Hydrostatic or colonoscopic decompression are unlikely to succeed and surgery is usually required. If the cecum is compromised, resection is required. Primary anastomosis is performed unless there are extenuating comorbid conditions, in which case an ileostomy and mucous fistula can be created. Even when the cecum is viable, resection is still definitive treatment because of the high rate of recurrence and the incomplete effectiveness of pexy of the large redundant sac, either by suturing or cecostomy.
A D V E R T I S E M E N T
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Occasionally, a mobile cecum will fold back on itself, a condition called a bascule (from the French verb meaning to swing). While the cecal volvulus involves a part of terminal ilium in the twist, the bascule does not. Treatment options are the same as for cecal volvulus.
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A D V E R T I S E M E N T
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Sigmoid volvulus, the most common, results in a closed loop extending from lower left to upper right, and is often massively distended. In contrast to cecal volvulus, attempt should be first made to decompress and devolvulize the sigmoid with rectal tube, endoscopy or cautious contrast enema. The latter should be avoided if there are peritoneal signs indicating a compromised sigmoid wall that might perforate. If decompression can be accomplished safely, it avoids an emergency operation with unprepped bowel. Workup can then be done to determine if there is an underlying pathology such as short segment Hirschsprung’s or global colonic inertia, and the appropriate therapy determined. If resection is indicated, usually because of the high (> 55%) risk of recurrence, it can be done electively with bowel prep, and medical optimization.
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This page was last modified on 4/17/2003.
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