Cecal Volvulus

Medically reviewed by Suzanne Falck, MD on November 9, 2017Written by Kristeen Cherney on November 9, 2017

Overview

Cecal volvulus is a rare form of intestinal obstruction. It occurs when the cecum, which is between the small bowel and colon, detaches from the abdominal wall and twists on itself.

This is different from gastric and sigmoid volvulus. The former refers to the twisting of the stomach, while the latter consists of a twisting together of parts of the colon and pelvis.

You likely won’t be able to tell you have cecal volvulus. In fact, you might think the painful and uncomfortable symptoms are linked to a stomach issue. Only your doctor can diagnose this condition with the help of imaging tests.

When caught early, cecal volvulus may be treated successfully. However, the condition is rare and difficult to diagnose, which means it often goes undetected. This can lead to serious consequences.

Symptoms of cecal volvulus

The following symptoms may be experienced with cecal volvulus:

  • ballooning abdomen (abdominal distension)
  • constipation
  • diarrhea
  • trouble passing gas
  • severe abdominal pain
  • vomiting

Diagnosing cecal volvulus may be difficult because its symptoms mimic those of other conditions. Sometimes, these symptoms are mistaken for inflammatory bowel syndrome (IBS) or inflammatory bowel disease (IBD). However, neither IBS nor IBD involve intestinal obstruction.

Unfortunately, both IBS and IBD — as well as cecal volvulus — are intermittent, so the symptoms come and go. As a rule of thumb, see your doctor for any of these symptoms, especially if they come and go over a long period of time.

Possible causes of cecal volvulus

Cecal volvulus affects the lower gastrointestinal (GI) tract. This portion of the GI tract extends from the large intestine to the anus. The large intestine takes in leftover nutrients from the foods you eat and drink, turning them into waste via the colon and rectum. The cecum acts as a barrier between the small and large intestines.

When there’s obstruction in this area, your large intestine still takes in the extra nutrients, but it can’t get rid of them. With cecal volvulus, the colon is twisted and can’t work properly because of interference from cecum detachment. According to Radiopaedia, this condition accounts for roughly 10 percent of all volvuli of the intestinal tract. It also tends to affect people ages 30 to 60.

Possible causes and risk factors may include:

  • air travel in low cabin pressure
  • colon muscle weakness (atonia)
  • enlargement of the colon
  • Hirschsprung’s disease (where the large intestine becomes inflamed and leads to constipation and obstruction)
  • infections
  • overexertion
  • pelvic tumors
  • pregnancy (especially in the third trimester)
  • previous abdominal surgeries that caused adhesions
  • violent coughing fits

How is it diagnosed?

Aside from a physical exam, your doctor will order imaging tests to help diagnose cecal volvulus. They might also feel your abdominal area to assess any areas of swelling.

Imaging tests may include a CT scan or an X-ray. With these tests, your doctor can look for descending or rounding movements of the large bowel. The result can look like the shape of a bird’s beak. They can also look for any twisting with the colon as a result. Your appendix may also be bloated from excess air.

A contrast enema is also sometimes used to help your doctor pinpoint the area of twisting and subsequent obstruction.

Treatment options

Surgery is the preferred method of treatment for cecal volvulus. According to the National Institute of Diabetes and Digestive and Kidney Diseases, surgery for this condition has a high success rate. It also decreases your risk for getting cecal volvulus again.

  • Cecopexy. The procedure for treating cecal volvulus is called a cecopexy. Your surgeon will move the cecum back to its proper position in the abdominal wall.
  • Intestinal resection surgery. If the cecum is severely damaged from being twisted, your doctor may recommend intestinal resection surgery.
  • Colonoscopic reduction. If you’re not a good candidate for surgery, your doctor might recommend a colonoscopic reduction. With this option, however, there’s a good chance of cecal volvulus returning.

Complications

When left untreated, cecal volvulus can lead to more intense symptoms. Constipation may worsen, and abdominal distension can increase.

Death is possible if the condition progresses. In fact, researchers report a mortality rate of up to 40 percent.

Outlook

Cecal volvulus is relatively rare, according to The Eurasian Journal of Medicine. Its symptoms mimic other conditions of the GI tract, and it’s difficult to diagnose. The only way to fully treat this condition is through surgery.

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