English

Abstract

A volvulus of cecum and ascending colon (cecocolic volvulus) is a relatively uncommon cause of large bowel obstruction. Congenital or acquired anatomic variations with or without precipitating factors may be associated with an increased risk of right colon volvulus. We report a case of 21-year young man, who presented in emergency with progressively worsening abdominal pain, distension and features of peritonitis. The plain abdominal radiograms were suggestive of the cecal loop in the left upper quadrant with likely cecalvolvulus. Patient was taken for an emergency exploratory laparotomy. At surgery volvulus of the cecum and ascending colon involving adjacent terminal ileum with gangrenous changes was found. Right-hemicolectomy with the formation of an ileostomy and a distal mucous fistula was performed. On account of high mortality rate, an early diagnosis and definitive treatment is essential for a favorable outcome. We discuss here this uncommon condition, various management options, its controversies and review the pertinent literature to conceptualize treatment options for the diverse clinical situations. Resection of the affected bowel segment with anastomosis (primary or delayed) is the preferred surgical treatment. The consent has been obtained from the patient and parents. INTRODUCTION:The condition commonly referred to as cecal volvulus is actually a cecocolic volvulus and consists of an axial rotation of the terminal ileum, cecum, and ascending colon with concomitant twisting of the associated mesentery1. It is an uncommon variety of colonic volvulus with sigmoid volvulus beingmore common. Developmental anomaly of the rotation and imperfect fixation of the cecum and ascending colon predisposes to this condition. Studies on cadavers have shown that between 11% - 22% of people have a right colon that is sufficiently mobile to allow a volvulus to occur 1. Other factors that have been implicated in causing a cecocolic volvulus include previous surgery, pregnancy, and obstructing lesions of the left colon.Cecocolic volvulus affects younger age group than sigmoid volvulus and also carries a higher mortality rate than the later. The diagnosis is often based on the plain abdominal radiograms with distended and translocated, cecal and colonic gas patterns seen in the epigastrium and left-upper quadrant. The treatment in the acute cases is undoubtedly emergency surgical procedure. The management option for gangrenous bowel is a debatable topic. We present a case of cecocolic volvulus with gangrene and discuss the various management options and its controversies. With review of the literature; this article endeavors to formulate operative treatment plan in different situations as per operative findings of a case with varying degree of bowel ischemia and gangrene. CASE REPORT: A 21-year male presented with a 2-days history of intermittent cramp-like, abdominal pain, vomiting and distension. He had no bowel movements in the past 3-days. Medical history was insignificant with no history of previous surgery.