Three Surgical Cases of Cecal Volvulus

Cecal volvulus (CV) is a relatively rare disease; however, it often requires emergency surgery due to the low success rate of endoscopic treatment, in contrast to sigmoid volvulus. The mechanism of CV involves a mobile cecum at the base, triggered by factors such as constipation, high-fiber diets, laxative use, history of laparotomy or laparoscopic surgery, pregnancy, and prior colonoscopy, which twists the ileocecal region. Although CV is a benign disease, it can be fatal if treatment is delayed, so it is crucial to understand the pathophysiology and treatment. In this report, we describe three cases of CV surgery that were all treated within a relatively short period. The patient in case 1, who was a woman in her 70s on steroid therapy for collagen disease, had abdominal fullness. CV was diagnosed by computed tomography (CT), and emergency surgery was performed. Indocyanine green (ICG) fluorescence imaging was performed intraoperatively to confirm that blood flow in the ileocecal area was intact, after which a cecopexy was performed. Case 2 revealed abdominal fullness in a woman in her 50s undergoing depression treatment. The CT diagnosis of CV led to the performance of emergency surgery. The intraoperative findings revealed intestinal ischemia, leading to the performance of an ileocecal resection. Case 3 involved a man in his 70s, suffering from cardiac amyloidosis and heart failure (HF) and in a long-term bedridden state, who was experiencing abdominal pain. The patient was diagnosed with CV by CT, but due to his poor general condition, colonoscopic treatment was first attempted. The endoscopic findings revealed intestinal strangulation, so ileocecal resection was performed on the following day. The patients in the three CV cases were relatively elderly, and all had some comorbidities. CT was effective for diagnosing CV, and emergency surgeries were necessary. The use of ICG imaging and the performance of cecopexy were also important, depending on the patient's condition.