Caecal Volvulus: A District General Hospital Experience and Review of the Literature
Abstract
:1. Introduction
2. Methodology
3. Results
4. Discussion
4.1. Demography
4.2. Clinical Presentation
4.3. Aetiology
4.4. Radiological Investigations
4.4.1. Conventional Radiography
4.4.2. Computerised Tomography (CT) Scan
4.5. Management
5. Learning Points/Highlights
- Variable clinical presentation in different population
- CT scan confirms diagnosis in >90%
- Typical Radiological Signs are described
- Representative X-ray and CT images presented
- Resectional procedures are favoured
- Secondary pathology as cancer might be the cause
- Significant morbidity expected but mortality is declining.
6. Limitations
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Number, (Range or Percentage) | Remarks |
---|---|---|
Total Patients | 16 | |
Gender, M:F | 5:11 | |
Median Age, years | 64 (33–80) |
Variables | Number, (Range or Percentage) | Remarks |
---|---|---|
ASA Grade | ||
I | 5 (31.2%) | |
II | 3 (18.8%) | |
III | 7 (43.7%) | |
IV | 1 (6.3%) | |
Co-morbidities | Hypertension, ischaemic heart disease, diabetes mellitus, COPD, and depression. | |
None | 5 (31.2%) | |
Single or Multiple | 11 (68.8%) | |
Use of psychotropic drugs | 6 (37.5%) | |
Abdomen pain, distension, and vomiting | 16 (100%) | |
Previous abdominal surgery | Nephrectomy, laparoscopic sterilisation, sigmoid colectomy, hysterectomy. | |
None | 11 (68.7%) | |
One | 3 | |
Multiple | 2 | |
History of large bowel volvulus | 1 (6.8%) | Sigmoid resection for volvulus 4 years before this admission. |
Initial diagnosis by emergency physician: | ||
Large bowel obstruction | 6 (37.5%) | |
Small bowel obstruction | 2 (12.5%) | |
Others | 8 (50.0%) | |
Acute appendicitis | 2 | |
Post-op collection | 1 | |
Urinary tract infection | 1 | |
Viscus perforation | 1 | |
Pancreatitis | 1 | |
Biliary colic | 1 | |
Gastroenteritis | 1 |
Variables | Number, (Range or Percentage) | Remarks |
---|---|---|
Abdominal radiograph | 11 (68.75%) | Five patients had CT as the only imaging. |
Non-specific bowel loops/SBO | 5 (46%) | |
Classical single loop of large bowel | 6 (54%) | |
CT Abdomen and pelvis | 15 | One patient operated without CT. |
CV not described | 1 | |
CV correctly identified | 14 (93.3%) | |
Caecal diameter >10 cm | 10 (67%) | |
Whirl sign | 12 (80%) | |
Split-wall sign | 13 (86.6%) | |
X-marks-the-spot sign | 14 (93.3%) | |
Double transition point | 13 (86.6%) | |
Ileocaecal twist | 13 (86.6%) | |
Central appendix | 11 (73.3%) |
Variables | Number, (Range or Percentage) | Remarks |
---|---|---|
Intervention | ||
Conservative Management | 1 (6.25%) | |
Surgery | 15 (93.7%) | |
Laparoscopic | 1 (6.25%) | |
Open | 14 (93.3%) | |
Intraoperative Findings | ||
Gangrenous Caecum | 1 (6.7%) | |
Patchy ischaemia | 12 (80%) | |
No ischaemia | 2 | |
Procedure | ||
Resection and primary anastomosis | 14 (93.3%) | |
Resection, ileostomy, and mucous fistula | 1 | |
Complications | ||
30-day mortality in conservatively managed | 1 (100%) | |
30-day mortality in operated patients | None | |
Uneventful recovery | 3 (20%) | |
Morbidity | 12 (80%) | |
Postoperative complications (Clavien–Dindo) | ||
I | 5 | |
II | 3 | |
III | 7 | |
IV | 1 | |
Major Morbidity | ||
Anastomosis Leak | 2 | |
CT guided Drainage | 1 | |
Re-operation and ileostomy | 1 | |
Reoperation | 3 | |
Anastomotic leak | 1 | |
Fascial Dehiscence | 1 | |
Bowel Obstruction/suspicion of ischaemia | 1 | |
Median Length of stay (days) | 10 (1–49) | |
Histopathology | ||
Low grade appendiceal mucinous neoplasm (LAMN) | 1 | |
Tubular Adenoma | 1 | |
Adenocarcinoma | 1 | |
No additional pathology | 12 | |
Median follow-up | 20 months (6–31) |
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Pangeni, A.; Chowdhury, A.; Rai, S.; Colledge, J.Y.; Shrestha, A.K. Caecal Volvulus: A District General Hospital Experience and Review of the Literature. Surgeries 2022, 3, 78-91. https://doi.org/10.3390/surgeries3020010
Pangeni A, Chowdhury A, Rai S, Colledge JY, Shrestha AK. Caecal Volvulus: A District General Hospital Experience and Review of the Literature. Surgeries. 2022; 3(2):78-91. https://doi.org/10.3390/surgeries3020010
Chicago/Turabian StylePangeni, Anang, Ashim Chowdhury, Sujata Rai, Jann Yee Colledge, and Ashish Kiran Shrestha. 2022. "Caecal Volvulus: A District General Hospital Experience and Review of the Literature" Surgeries 3, no. 2: 78-91. https://doi.org/10.3390/surgeries3020010