Cecal volvulus in giant ventral hernia

Colonic volvulus is the third leading cause of the colonic obstruction with cecal volvulus accounting for approximately 40% of all colonic volvulus. Lack of peritonealization of the right colon, adhesions from prior surgery, colonic atony, and distal colonic obstruction are potential risks factors for the development of cecal volvulus.

63 year old male with history of multiple prior intraabdominal surgeries and recurrent ventral hernia. Presented with colon perforation, as a result of cecal volvulus, which was contained in a giant ventral hernia. Diagnosis of cecal volvulus was suspected based on preoperative imaging studies, and confirmed in the OR. Patient underwent damage control procedure with subsequent challenging abdominal wall closure.

Axial cecal volvulus and cecal bascule are representing two types of cecal volvulus. Both of these types require a mobile cecum and presence of right colon to occur. It is generally accepted, that mobile cecum is a congenital condition, but in certain situations, particularly after prior intraabdominal surgeries, cecum may lose fixation points and potentially become vulnerable to twisting. This patient with long history of large recurrent ventral hernia had mobile cecum inside the hernia sac and developed cecal volvulus.

We present a unique case of cecal volvulus in giant ventral hernia after multiple prior intraabdominal surgeries. Challenges in management of this exceptionally difficult patient were discussed. Large ventral hernia with mobile cecum inside hernia sac is a risk factor for cecal volvulus.