Delayed Presentation of Cecal Volvulus Increases Mortality Risk
Cecal volvulus is the second most common form of colonic volvulus after sigmoid volvulus and represents approximately 1–1.5% of all adult intestinal obstruction. In a recent study, researchers have found that cecal volvulus carries a high risk of mortality which is associated with delayed preoperative diagnosis and treatment. The study findings were published in the BMC Surgery on December 19, 2021.
Cecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. Various reports have described cecal volvulus within the literature, typically with individual or few patients. Therefore, Dr Robert K. Parker and his team conducted a study to review the clinical presentation, management, and outcome of patients with cecal volvulus at a referral hospital in rural Kenya.
In this retrospective review, the researchers included 13 patients with a diagnosis of cecal volvulus between January 1st, 2009 and December 31st, 2019 at Tenwek Hospital in Bomet, Kenya. All patients presented with abdominal pain and distension. They compared the outcome of survival by the time to presentation. They also compared the mortality with prior reports of intestinal obstruction at our institution.
Key findings of the study:
- Among 13 patients, the researchers observed seven patients (54%) presented with perforation, gangrene, or gross peritoneal contamination.
- They noted that common risk factors were Ladds bands with malrotation, adhesions, and a sigmoid tumour.
- Procedures performed include 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).
- They found four mortalities (31%), of which all had delayed presentation with perforation and fecal contamination.
- They observed that delays to the presentation were associated with mortality.
- They further noted that cecal volvulus resulted in increased perioperative mortality compared to all intestinal obstructions presenting to the institution.
The authors concluded, "The etiology of cecal volvulus is multifactorial, with an underlying anatomic predisposition. Cecal 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."
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