Volvulus cecum: symptoms, causes, diagnosis and treatment

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Cecal volvulus is a type of intestinal malrotation that occurs in the lower part of the intestine. It can affect the cecum, ileum, or colon. Cecal volvulus is not as common as other types of volvulus , but all can lead to potentially serious intestinal obstruction. Sometimes people have recurring chronic symptoms before an acute torsion occurs. An acute blockage or volvulus is a medical emergency that usually requires surgery .

Get Medical Information / Jessica Olah

Symptoms

During the last phase of fetal development, one of the most important changes that take place in the embryo occurs in the intestines. At this time, the mesentery attaches the intestines to the abdominal wall. The intestines move to digest food (peristalsis), but it is this important connection that prevents them from moving, twisting, or bending, which can damage the intestines.

In some cases, the lower part of the cecum does not adhere firmly (or does not adhere at all) during this period of fetal development. This allows the cecum to move freely (moving cecum syndrome). Sometimes the disease is diagnosed during surgery or by X-ray.

Many people would never realize that they have a moving blind because they do not experience any symptoms or problems.

Certain circumstances or conditions can increase the likelihood that a predisposed person will have a problem with a moving cecum, such as pregnancy, abdominal surgery, or infection. Other factors, such as a diet rich in fiber, can also play a role.

If a person has symptoms of caecal volvulus, at first they may be intermittent, recurrent, and chronic. Over time, they can lead to an acute and potentially serious bowel obstruction. Many people develop acute obstruction without prior symptoms indicating partial obstruction.

Symptoms mimic many other gastrointestinal disorders, which can make diagnosis difficult. It is not very common for healthcare professionals to see cases of volvulus, especially when compared to another type of volvulus that affects the sigmoid colon (sigmoid volvulus). Therefore, the diagnosis of volvulus of the cecum may be missed or delayed.

When a portion of the intestine is twisted, the portion over the compartment continues to function. When food, liquid, gas, and stool travel through the intestines and reach the bent or twisted parts of the intestine, the person begins to feel unwell.

Symptoms of volvulus cecum include:

  • Abdominal pain: When the condition is chronic / recurring, the pain can be vague and intermittent, and the person tends to feel better when they have gas or a bowel movement. When the pain is severe and persistent, it usually indicates that the condition is acute or that complications such as gangrene have occurred.
  • Swelling
  • High bowel noises
  • Inability to pass gas or defecate
  • Nausea and lack of appetite.
  • Threw up
  • Black, tarry stools
  • Chronic constipation and / or diarrhea.

When the twisting has not resulted in a complete bowel obstruction , people may feel relieved as soon as they can drain the gas, a sign that the twisting has resolved on its own. When the blockage can't go away on its own or complications occur, pain and other symptoms get worse.

If a person continues to experience recurrent episodes of volvulus, complications can occur, even if an acute obstruction does not occur. When the intestines twist, the blood supply is cut off. Over time, repeated interruptions to normal blood flow in the same part of the intestine can cause the intestines to stop working.

Lack of treatment for volvulus of the cecum can also lead to life-threatening infections such as sepsis or gangrene. as the tissue dies (necrosis). As the pattern continues, symptoms can gradually get worse as the intestines lose their ability to function properly. People can also experience deterioration in health due to malnutrition and malabsorption.

Although volvulus is not common in children , it is more likely to present with general symptoms such as fatigue, loss of energy, unwillingness to eat, and vague abdominal pain.

Intestinal malrotation can also be present in newborns, usually during the first month after birth. In these cases, baby boys are more likely to develop symptoms (which may initially be mistaken for colic). Cases that occur at a later age appear to occur equally between men and women.

Causes

Cecal volvulus is rare, but there are certain conditions that can make a person more likely to develop it. As mentioned above, the presence of a mobile cecum is in some cases a known predisposing factor. It is estimated that about 10 percent of the population has a blind that is not properly attached, although this number may be small .

Many people never have symptoms, and the condition is noticed only occasionally, if at all, during their lifetime. In fact, many cases are not discovered until after a person's death and an autopsy is performed.

Other diseases and conditions that can lead to swelling include :

  • Chronic constipation
  • Injuries caused by conditions such as diverticulitis .
  • A lump or swelling in the pelvis or abdomen.
  • Hirschsprung's disease and other intestinal diseases (especially those that cause an enlarged colon)
  • Bowel adhesions from surgery, inflammation, infection, or trauma
  • A condition called intestinal obstruction, which can occur after surgery or procedures in which the intestines are calmed with anesthesia and sedation.
  • Organ displacement due to pregnancy

Most cases are diagnosed in elderly patients who are acutely or hospitalized, although not necessarily initially with intestinal complaints. Older people, people with chronic illnesses, or people with an acute illness with another medical condition that requires hospitalization are at increased risk of complications if they develop volvulus, including strangulation or bowel perforation.

Diagnostics

Cecal volvulus is commonly seen in adults of both sexes and all racial groups between the ages of 30 and 60. The symptoms of caecal volvulus can be similar to those of other gastrointestinal conditions, such as appendicitis, irritable bowel syndrome, inflammatory bowel disease, and gastroenteritis (stomach flu).

If a person's symptoms are repetitive, intermittent, and resolve spontaneously rather than acutely, it may take longer to diagnose. When the condition becomes acute, several types of imaging tests can be used to determine the cause.

In the emergency room, the doctor usually orders a plain X-ray of the abdomen first to determine if the intestine is blocked. Sometimes a contrast enema can be given to make different parts of the intestine more visible on x-rays or other images, such as CT scans. This can help healthcare providers see where the roadblock is and what could be causing it.

If a person has had symptoms before, they can also look for signs of damage or infection caused by a previous episode of caecal volvulus that got better on its own. If there is concern about an infection or if the person is very ill, the doctor may order other tests to evaluate it.

Other tests that may be ordered if a healthcare provider suspects that a person has cecal volvulus include:

  • blood tests to look for white blood cell counts, which may indicate an infection
  • a comprehensive metabolic panel to assess your overall health, which may be important to find out if they need surgery
  • sigmoidoscopy or colonoscopy to look inside the small intestine

Watch out

Surgery is necessary in most cases of caecal volvulus. However, the procedure the surgeon chooses will depend on the cause of the swelling and the person's health. In some cases, healthcare providers may want to try other methods of reducing swelling that do not require surgery.

Treatment of volvulus can be difficult; Even with surgery, it is a problem that tends to come back (recur) and can get worse over time. A person who experiences volvulus due to the presence of a mobile cecum is likely to have recurrent episodes of volvulus if the loose bowel section is not repaired.

If part of the intestine has stopped working or the tissue is suffocating, it may need to be completely removed to prevent infection and help restore bowel function.

There are several surgical procedures that can be performed to treat caecal volvulus. The surgeon will choose the procedure that he thinks will have the best results and the least risk for each person. When a person is admitted to the hospital and diagnosed with acute volvulus of the cecum, elective surgery can usually be done the same day or very soon after the visit.

Surgical procedures that can be used to treat cecal volvulus include:

  • Cecoplegia: If a person's intestine is not properly attached (mobile or flexible cecum), it can adhere or reattach to the abdominal wall. To perform this procedure, the intestines must be healthy and functional.
  • Colon and stoma resection: If part of the intestine is no longer functioning or has become necrotic, the surgeon may need to remove it completely. One way to do this is by resecting the colon and forming a stoma , an artificial opening made into the abdominal cavity. Stool can pass through the stoma and collect in a bag that can be carried outside the body called an ostomy.

Sometimes stomas are temporary and later another surgery may be done to restore the bowel connection. If successful, the stoma can be closed. If the intestines cannot be repaired, the person should keep the stoma and wear an ostomy bag so that stool can pass out of the body.

The surgeon generally attempts to perform these procedures using minimally invasive techniques such as laparoscopy. However, in more complex cases, they may need to use or switch to a more invasive (open) technique. The possibility of complications and the time it takes for a person to recover will depend on the type of surgery that is performed.

In some cases, the doctor may want to try a more conservative treatment before surgery. This option is only possible for patients who are considered medically stable and who do not show signs of intestinal perforation or infection.

Nonsurgical treatment options for caecal volvulus include decompression of the intestines with colonoscopy. This method allows the intestines to be straightened in approximately 30% of cases; however, this is only a temporary measure and the intestines usually twist or collapse again.

Cecal volvulus is not a common condition and surgeons may only see a few cases in their careers. Therefore, there are no definitive guidelines or treatment recommendations for all cases. Medical professionals will make treatment decisions on an individual basis, taking into account the individual's health and medical history, their own experience, and the surgical knowledge and capabilities of the hospital in which they work.

Get the word of drug information

Cecal volvulus is a rare cause of intestinal obstruction and is more common in adults. The cases of volvulus of the cecum can be recurrent (come and go) and resolve spontaneously on their own, but they can also be or become acute and cause a partial or complete intestinal obstruction.

Although there is no definitive treatment, most patients will need surgery, especially if part of their intestines has been damaged by repeated episodes of volvulus. Be sure to discuss your options with your doctor, who can evaluate the best options for you based on your individual needs.

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