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Cecal volvulus. A case for nonresectional therapy

R S Howard, J Catto

    Archives of Surgery (Chicago, Ill. : 1960)
    |March 1, 1980
    PubMed
    Summary
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    Acute cecal volvulus in adults can often be treated with nonresectional procedures, avoiding surgery for recurrence. This study suggests resection is unnecessary unless necrosis is present.

    Area of Science:

    • Gastroenterology
    • Abdominal Surgery
    • Surgical Case Review

    Background:

    • Cecal volvulus is a rare but serious cause of acute abdomen.
    • Previous literature often recommended surgical resection for cecal volvulus, particularly in cases without necrosis.
    • Risk factors and optimal management strategies require further elucidation.

    Purpose of the Study:

    • To evaluate the outcomes of nonresectional management for acute cecal volvulus.
    • To assess the recurrence rate and long-term follow-up after nonresectional procedures.
    • To challenge the traditional view that resection is always necessary for cecal volvulus.

    Main Methods:

    • Retrospective review of 16 adult patients diagnosed with acute cecal volvulus.
    • Analysis of patient demographics, prior surgical history (especially gynecologic procedures), and diagnostic imaging (plain films, barium enema).

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  • Evaluation of treatment modalities, focusing on nonresectional interventions and long-term follow-up (average 5.6 years).

    • Main Results:

    • The study included 14 female and 2 male patients, with an average age of 47 years; 62% were under 50.
    • Eighty-one percent had prior operations, 30% within the preceding month, often gynecologic procedures.
    • Plain abdominal films and barium enemas were diagnostic or highly suspicious.
    • Fourteen patients underwent nonresectional procedures with no subsequent operations for recurrence.

    Conclusions:

    • Nonresectional management appears effective for acute cecal volvulus, with no observed recurrences in this cohort.
    • The data do not support the necessity of resection for cecal volvulus in the absence of necrosis.
    • This suggests a shift in management paradigms towards less invasive approaches when feasible.