VOLVULUS OF THE CECUM AND ASCENDING COLON: A CASE REPORT AND REVIEW OF THE LITERATURE

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.