Cecal volvulus: analysis of 50 patients with long-term follow-up

Fifty patients operated upon for cecal volvulus were analyzed. The ages ranged from 14 to 88 years and averaged 53 years. Eighteen were males and 32 were females. The presentation was acute, requiring urgent surgery in 41 patients; nine patients presented with chronic symptoms and were operated upon electively. In 14 patients (28%) the cecal volvulus was temporally related to another acute medical problem. The diagnosis was made radiographically in 22 patients (44%) and at operation in 28 patients (56%). Cecal volvulus was correctly diagnosed by barium enema in 20 of the 29 patients (69%) undergoing the study. Eighteen of the patients were treated by cecopexy, 14 by resection, 12 by detorsion alone, and six by tube cecostomy. Mortality was 12% (6/50) and was associated with gangrenous cecum (33%, 3/9), other systemic diseases (24%, 5/21), age over 50 years (19%, 6/31), and acute presentation (15%, 6/41). In the absence of gangrenous cecum, enterotomy was associated with subsequent wound infection in 23% (7/30), as compared to none (0/11) when enterotomy was not performed. There were no recurrences of cecal volvulus in the entire series during follow-up which extended to 17 years, averaged 5.7 years, and was complete in 96% (42/44) of survivors. When gangrenous cecum is present, resection is the treatment of choice. In the absence of gangrenous bowel, cecopexy is recommended because of a low mortality (0/18), low morbidity (3/18), low recurrence rate (0/18) and absence of need to open the unprepped bowel.