eMedicine Specialties > Radiology > Gastrointestinal

Cecal Volvulus: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK
Coauthor(s): Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Yousif Al-Khattab, MBChB, DMRD, FRCR, Consulting Staff, Department of Radiology, North Manchester Healthcare Trust, UK; John MT Howat, MB, BCh, MD, FRCS, Consultant General and Colorectal Surgeon, North Manchester General Hospital, UK
Contributor Information and Disclosures

Updated: Aug 31, 2009

Intervention

An attempt should always be made to reduce the volvulus with barium enema examination, unless contraindications are present (see Medical/Legal Pitfalls below). Reduction with barium enema examination is particularly successful in the rare cecal volvulus that occurs in the postpartum patient. The volvulus may reduce during evacuation of the contrast agent.

Surgery is required in many patients. Surgery is urgent after reduction in those with gross abdominal tenderness or in those in whom leukocytosis suggests ischemia.

The postoperative abdomen, especially after closed segmental resection of the descending colon, presumably with stenosis, is a precipitating cause of cecal volvulus. After colonic resection and anastomosis, evaluation of the colon with a barium enema is undesirable, no matter how carefully the procedure is performed. Evaluation with water-soluble contrast material has been used to evaluate the postoperative colon. The safety of this procedure in the postoperative abdomen cannot yet be determined because experience is limited.

Medicolegal Pitfalls

  • The contraindications for a barium enema are the following: signs and symptoms of peritonitis, rectal bleeding, radiographic signs of gas in the bowel wall, and pneumoperitoneum.
  • Overdistention of the cecum with air and/or barium during a barium enema examination may result in cecal perforation.

 


More on Cecal Volvulus

Overview: Cecal Volvulus
Imaging: Cecal Volvulus
Follow-up: Cecal Volvulus
Multimedia: Cecal Volvulus
References
Further Reading
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References

  1. Perret RS, Kunberger LE. Case 4: Cecal volvulus. AJR Am J Roentgenol. Sep 1998;171(3):855, 859, 860. [Medline].

  2. Hashimoto Y, Shigemoto S, Nakashima A, Murakami Y, Sueda T. Successful preoperative diagnosis of a rare bowel obstruction: cecal volvulus. J Gastrointest Surg. Jan 2008;12(1):202-4. [Medline].

  3. Frank AJ, Goffner LB, Fruauff AA. Cecal volvulus: the CT whirl sign. Abdom Imaging. 1993;18(3):288-9. [Medline].

  4. Hoeffel C, Crema MD, Belkacem A, Azizi L, Lewin M, Arrivé L. Multi-detector row CT: spectrum of diseases involving the ileocecal area. Radiographics. Sep-Oct 2006;26(5):1373-90. [Medline].

  5. Delabrousse E, Sarliève P, Sailley N, Aubry S, Kastler BA. Cecal volvulus: CT findings and correlation with pathophysiology. Emerg Radiol. Nov 2007;14(6):411-5. [Medline].

  6. Yeh WC, Wang HP, Chen C. Preoperative sonographic diagnosis of midgut malrotation with volvulus in adults: the "whirlpool" sign. J Clin Ultrasound. Jun 1999;27(5):279-83. [Medline].

  7. Ruiz-Tovar J, Calero García P, Morales Castiñeiras V, Martínez Molina E. [Caecal volvulus: presentation of 18 cases and review of literature]. Cir Esp. Feb 2009;85(2):110-3. [Medline].

  8. Wolfer J A, Beaton, L E, Anson B J. Volvulus of the cecum: Anatomical factors in its etiology. Surg Gynecol. Obstet. 1942;74:882.

  9. Rivo, M., Farrell, G.E., Schauffer, I. A. The association of volvulus of the cecum and ascending colon with obstructive colonic lesions. Am. J. Roentgenol. 1957;78:587-590.

  10. Torreggiani WC, Brenner C, Micallef M. Case report: Caecal volvulus in association with a mesenteric dermoid. Clin Radiol. May 2001;56(5):430-2. [Medline].

  11. Hogan BA, Brown CJ, Brown JA. Cecal volvulus in pregnancy: report of a case and review of the safety and utility of medical diagnostic imaging in the assessment of the acute abdomen during pregnancy. Emerg Radiol. Mar 2008;15(2):127-131. [Medline].

  12. Rabin MS, Richter IA. Caecal bascule--a potential clinical and radiological pitfall. Case reports. S Afr Med J. Aug 5 1978;54(6):242-4. [Medline].

  13. Takada K, Hamada Y, Sato M, Fujii Y, Teraguchi M, Kaneko K. Cecal volvulus in children with mental disability. Pediatr Surg Int. Oct 2007;23(10):1011-4. [Medline].

  14. Ramirez R, Chaumoître K, Michel F, Sabiani F, Merrot T. [Intestinal obstruction in children due to isolated intestinal malrotation. Report of 11 cases]. Arch Pediatr. Feb 2009;16(2):99-105. [Medline].

  15. Hsu SD, Yu JC, Chou SJ, Hsieh HF, Chang TH, Liu YC. Midgut volvulus in an adult with congenital malrotation. Am J Surg. Mar 18 2008;[Epub ahead of print]. [Medline].

  16. Yoo SJ, Park KW, Cho SY. Definitive diagnosis of intestinal volvulus in utero. Ultrasound Obstet Gynecol. Mar 1999;13(3):200-3. [Medline].

  17. Moore CJ, Corl FM, Fishman EK. CT of cecal volvulus: unraveling the image. AJR Am J Roentgenol. Jul 2001;177(1):95-8. [Medline].

  18. Green P, Swischuk LE, Hernandez JA. Delayed presentation of malrotation and midgut volvulus: imaging findings. Review. Emerg Radiol. Nov 2007;14(6):379-82. [Medline].

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Keywords

cecal volvulus, torsion of the ascending colon, closed-loop obstruction of the ascending colon and cecum, axial torsion, cecal bascule

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, British Medical Association, British Society of Interventional Radiology, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Yousif Al-Khattab, MBChB, DMRD, FRCR, Consulting Staff, Department of Radiology, North Manchester Healthcare Trust, UK
Disclosure: Nothing to disclose.

John MT Howat, MB, BCh, MD, FRCS, Consultant General and Colorectal Surgeon, North Manchester General Hospital, UK
John MT Howat, MB, BCh, MD, FRCS is a member of the following medical societies: Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Spencer B Gay, MD, Professor of Radiology, Director of Body Computed Tomography, Department of Radiology, University of Virginia Health Sciences Center
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

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