Cecal volvulus: outcome of management by celiotomy

Abstract

This study was undertaken to evaluate the care of patients with cecal volvulus recently treated in Department of Veterans Affairs (DVA) hospitals. This large contemporary review examines the outcomes of surgical treatment and is also the largest reported series of attempted colonoscopic decompressions. All patients with the ICD-9-CM code for colonic volvulus during the period 1991–1995 were identified in the computerized national DVA database. Data on patient demographics, clinical course, and outcomes were collected. Fifty-five patients with cecal volvulus and complete medical records were identified. The average age was 68 years; all were male. Previous abdominal surgery (5 of 55 patients; 9%), and neurologic impairment (6 of 55 patients; 11%) were the most common risk factors. Diagnosis was possible by plain radiography in the majority of patients (39 of 55; 71%). Colonoscopic decompression was attempted in 20 patients (36%), but was successful in only one (5%). The mortality rate was 18% for colectomy and primary anastomosis (5 of 28 procedures), 31% for colectomy and stoma formation (5 of 16 procedures), 11% for cecopexy (1 of 9 cases), and 100% for tube cecostomy (2 procedures). Mortality was significantly correlated with emergent surgery (p < 0.01). Cecal volvulus frequently presents as a surgical emergency, and continues to be associated with a high mortality rate. Prompt diagnosis is often possible with plain radiographs, but colonoscopic decompression is typically unsuccessful. Cecopexy provides a safe alternative to resection and primary anastomosis in suitably selected patients.