Caecal volvulus: A rare cause of bowel obstruction

Caecal volvulus is an uncommon but significant cause of intestinal obstruction.^1,2 Due to its nonspecific clinical presentation, diagnosis can be challenging, and delays may result in bowel ischemia or perforation. Early recognition and prompt surgical intervention are crucial to achieving favorable outcomes.

A 66-year-old male with a history of sacral chordoma treated by sacrectomy and radiotherapy presented with abdominal distension, pain, and signs of intestinal obstruction. His medical background included multiple abdominal surgeries, chronic renal insufficiency, chronic obstructive pulmonary disease, and a neurogenic bladder managed with self-catheterization. Abdominal CT revealed an organo-axial caecal volvulus without evidence of ischemia. Following unsuccessful conservative management, surgical exploration identified a perforated caecal volvulus with localized peritonitis. A right hemicolectomy with ileo-transverse anastomosis was performed. The postoperative course was uneventful, and the patient remained symptom-free at 12-week follow-up.

Caecal volvulus requires urgent diagnosis and timely surgical management to prevent ischemic or perforative complications. CT imaging remains the diagnostic modality of choice, aiding in early detection and surgical planning. Mortality is strongly associated with delayed intervention, particularly in elderly or medically complex patients. Definitive management through right hemicolectomy provides optimal outcomes and minimizes recurrence risk.

Caecal volvulus, though rare, should be considered in patients with bowel obstruction and relevant surgical history. Prompt diagnosis and definitive surgical treatment are key to reducing morbidity and mortality. This report has been prepared in accordance with the SCARE 2023 guidelines.³.