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Cecal volvulus in rural Kenya: delayed presentation contributes to high mortality
Kimutai R Sylvester1, Philip B Ooko2, Michael M Mwachiro1
1Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya.
BMC Surgery
|December 20, 2021
Summary
Cecal volvulus is a rare cause of intestinal obstruction with a high mortality rate, especially with delayed presentation. Early diagnosis and surgical intervention are crucial for improving patient outcomes in resource-limited settings.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Cecal volvulus, a rare cause of intestinal obstruction, involves torsion of the cecum, terminal ileum, and ascending colon.
- This condition leads to a closed-loop obstruction and is infrequently reported in adults.
Purpose of the Study:
- To review the clinical presentation, management strategies, and patient outcomes for cecal volvulus.
- To evaluate outcomes at a rural, resource-limited referral center.
Main Methods:
- A retrospective review of cecal volvulus cases from January 2009 to December 2019 at Tenwek Hospital, Kenya.
- Comparison of survival rates based on time to presentation and institutional mortality rates for intestinal obstruction.
Main Results:
- Thirteen patients (mean age 52 years) presented with abdominal pain and distension; 54% had perforation or gangrene.
- Risk factors included Ladds bands, malrotation, adhesions, and sigmoid tumor.
- Four mortalities (31%) occurred, all with delayed presentation; delayed presentation was linked to mortality (p=0.03).
Conclusions:
- Cecal volvulus has a high associated mortality risk.
- Early suspicion and diagnosis are vital to reduce mortality.
- Prompt surgical intervention is essential for managing this condition.
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