Chapter 47: Colon and Rectum- Cecal Volvulus Flashcards
What is it?
Twisting of the cecum upon itself and the mesentery
What is a cecal “bascule” volvulus?
Instead of the more common axial twist, the cecum folds upward (lies on the ascending colon)
What is the incidence?
≈25% of colonic volvulus (i.e., much less common than sigmoid volvulus)
What is the etiology?
- Idiopathic
- poor fixation of the right colon
- many patients have history ofabdominal surgery
What are the signs/symptoms?
- Acute onset of abdominal or colicky pain beginning in the RLQ and progressing to a constant pain
- vomiting
- obstipation
- abdominal distention
- and SBO
- many patients will have had previous similar episodes
How is the diagnosis made?
- Abdominal plain film
- dilated, ovoid colon with large air/fluid level in the RLQ
- often forming the classic “coffee bean” sign with the apex aiming toward the epigastrium or LUQ
- dilated, ovoid colon with large air/fluid level in the RLQ
- (must rule out gastric dilation with NG aspiration)
What diagnostic studies should be performed?
Water-soluble contrast study (Gastrografin®), if diagnosis cannot be made by AXR, CT scan
What is the treatment?
- Emergent surgery
- right colectomy with primary anastomosis
- or ileostomy and mucous fistula (primary anastomosis may be performed in stable patients)
What are the major differences in the EMERGENT management of cecal volvulus versus sigmoid?
Patients with cecal volvulus require surgical reduction, whereas the vast majority of patients with sigmoid volvulus undergo initial endoscopic reduction of the twist
Name the most likely diagnosis:
67-year-old male smoker on Coumadin®for chronic DVT notices LLQ pain after a strenuous coughing spell; LLQ mass detected on physical exam
Rectus sheath hematoma
What is the treatment?
60-year-old male with LLQ pain and “parrot’s beak” on x-ray c/w sigmoid volvulus
Proctosigmoidoscopy to decompress initially
78-year-old male with RLQ and “coffee bean” colonic dilation on x-ray c/w cecal volvulus
Ex lap with resection with primary anastomosis or ileostomy
