Surgical Management of Cecal Volvulus without Ischemia: A Case Report

Abstract

Introduction: Cecal volvulus, defined as torsion of the cecum, terminal ileum, and ascending colon around their mesenteric axis, is a rare but serious cause of acute intestinal obstruction. Because symptoms are often nonspecific, diagnosis may be delayed. Abdominal CT scan has become the key diagnostic tool, and surgery remains the treatment of choice. Case Report: The case of a 59-year-old man with type 2 diabetes and a history of cholecystectomy was reported. He was admitted for abdominal pain evolving over 24 hours, associated with vomiting, cessation of stool and gas passage, and mild rectal bleeding. The CT scan revealed a distended cecum with the characteristic whirl sign. Surgical exploration found an axial cecal volvulus with two clockwise twists, without evidence of bowel ischemia. A right ileo-hemicolectomy with manual ileocolic anastomosis was performed. Postoperative recovery was uneventful, and the patient was discharged in good condition. Diagnosis: Diagnosis is difficult due to variable pain intensity and nonspecific signs. It usually presents as an acute or subacute intestinal obstruction. A plain abdominal X-ray can be useful but has low sensitivity. Right hemicolectomy with primary anastomosis is recommended by several teams even in the absence of colonic necrosis, as it eliminates the risk of recurrence. This case highlights the importance of prompt radiologic diagnosis and appropriate surgical management to prevent complications and recurrence. Conclusion: Early diagnosis using a CT scan and prompt surgical management are crucial. Right ileo-hemicolectomy provides definitive treatment with minimal recurrence risk.