Caecal volvulus: a cause for intestinal obstruction

The diagnosis is rarely made preoperatively . Plain abdominal X-rays may show massive dilatation of the proximal colon with an empty distal bowel and two air-fluid levels caused by double closed-loop obstruction (at the level of the transverse colon and cecum), or a ‘bent inner tube appearance’; however, plain X-rays are not very sensitive, and may not contribute to the diagnosis. In such cases, a barium enema study may help in the diagnosis by showing the typical ‘bird’s beak’ appearance. 4,6 Computerised tomogram scan (CT scan) has the highest sensitivity, and will help delineate the closed loop obstruction, marked dilatation of the proximal colon and collapse of the distal portion of the transverse/descending colon, as well as the twisting of the mesenteric vessels, all of which suggest a TCV. 3,7 Although there are occasional reports of successful conservative management 8 of TCV, sur gery is usually required in the vast majority of cases. Depending on the status of the colon, the surgical options may vary from simple derotation (and colopexy) in patients with a viable colon, to resection (with or without primary anastomosis) in the presence of gangrene or perforation. Resection of the redundant transverse colon has the least chance of recurrence.