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Synchronous caecal and sigmoid volvulus: a surprise twist
Enda Hannan1, Esther Man Yu Lim1, Gerard Feeney1
1Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland.
Insights
Synchronous caecal volvulus (CV) and sigmoid volvulus (SV) are rare, presenting diagnostic challenges. This case highlights the need for cautious diagnosis and close observation after initial treatment for sigmoid volvulus.
Area of Science:
- Gastroenterology
- Surgical Case Reports
Background:
- Caecal volvulus (CV) and sigmoid volvulus (SV) are typically considered distinct clinical entities.
- Synchronous occurrence of both CV and SV is exceedingly rare, with limited literature available.
Purpose of the Study:
- To report a rare case of simultaneous caecal and sigmoid volvulus.
- To discuss the diagnostic challenges and implications of this rare presentation.
Main Methods:
- Case report of a patient presenting with symptoms suggestive of sigmoid volvulus.
- Diagnostic workup including plain abdominal X-ray and clinical observation.
- Endoscopic decompression of sigmoid volvulus followed by continued clinical monitoring.
Main Results:
- A rare case of synchronous caecal and sigmoid volvulus was identified.
- Classical 'coffee-bean' sign for SV on X-ray initially masked the concurrent CV.
- Patient's condition deteriorated despite successful endoscopic decompression of SV, prompting further investigation and revealing CV.
Conclusions:
- Synchronous caecal and sigmoid volvulus presents a significant diagnostic challenge.
- Clinical vigilance and a low threshold for re-evaluation are crucial when symptoms persist post-intervention for suspected SV.
- Accurate diagnosis of concurrent volvulus is essential for appropriate management and improved patient outcomes.
Abstract:
Traditionally, caecal volvulus (CV) and sigmoid volvulus (SV) have been thought of as largely separate clinical entities with distinct clinical features, radiological findings and treatment strategies. We present a rare case of synchronous CV and SV. To our knowledge, this represents only the ninth such case in the literature. This posed a diagnostic challenge as the seemingly textbook features of SV, such as the classical 'coffee-bean' sign on plain abdominal X-ray, masked the simultaneous occurrence of CV which only became apparent after the patient continued to deteriorate despite the successful endoscopic decompression of the SV. The diagnosis of SV should be made cautiously, with a period of close clinical observation post-intervention and a low threshold for re-evaluation should symptoms persist or recur to ensure accurate diagnosis.
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