Abstract
BackgroundCecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. It is a rare reported cause of adult intestinal obstruction. This study aimed to review the clinical presentation, management, and outcomes at a rural, resource-limited referral center.MethodsWe performed a retrospective review of all patients with a diagnosis of cecal volvulus between January 1st, 2009 and December 31st, 2019 at Tenwek Hospital in Bomet, Kenya. The outcome of survival was compared by the time to presentation. Mortality was also compared with prior reports of intestinal obstruction at our institution.ResultsThirteen patients were identified with a mean age of 52 years and a mean symptom duration of 5 days. All patients presented with abdominal pain and distension. Seven patients (54%) presented with perforation, gangrene, or gross peritoneal contamination. Identified risk factors were Ladds bands with malrotation, adhesions, and a sigmoid tumor. Procedures included primary resection and anastomosis (7), damage control (3) with anastomosis on second-look in 2 of these, simple surgical detorsion (1), and surgical detorsion and cecopexy (2). There were four mortalities (31%), of which all had delayed presentation with perforation and fecal contamination. Delays to presentation were associated with mortality (p = 0.03). Cecal volvulus resulted in increased perioperative mortality compared to all intestinal obstructions presenting to the institution (p < 0.0001).ConclusionsCecal volvulus carries a high risk of mortality. A high index of suspicion and early consideration in the differential diagnosis of intestinal obstruction should be considered to reduce the mortality associated with the delay in preoperative diagnosis.
Highlights
Cecal volvulus refers to torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery resulting in a closed-loop obstruction [1]
There is a paucity of data from the African continent of this condition, limited predominately to case reports [2, 3]
We hypothesized that cecal volvulus carries a higher risk of mortality in rural Africa than other forms of intestinal volvulus or Sylvester et al BMC Surgery (2021) 21:430 obstruction
Summary
Cecal volvulus refers to torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery resulting in a closed-loop obstruction [1]. We hypothesized that cecal volvulus carries a higher risk of mortality in rural Africa than other forms of intestinal volvulus or Sylvester et al BMC Surgery (2021) 21:430 obstruction. This study aimed to review clinical presentation, management, and outcome of patients with cecal volvulus at a referral hospital in rural Kenya. Cecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. It is a rare reported cause of adult intestinal obstruction. This study aimed to review the clinical presentation, management, and outcomes at a rural, resource-limited referral center
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
