Les volvulus du cæcum

The cecum is the second most common site of colonic volvulus after the sigmoid. The mechanism is torsion or hyperflexion of the enlarged, poorly-fixed, and hypermobile cecum. It presents clinically as an acute bowel obstruction with strangulation. Diagnosis can be made by plain abdominal X-ray in more than half the cases on the basis of cecal distention (with a classical « teardrop » or « comma » appearance), proximal small bowel distention with air-fluid levels, and a gasless distal colon. Barium enema shows lack of filling of the cecum, often with a « beaked » termination of the column of contrast. CT images are pathognomonic when they reveal a cecal « vortex. » After surgical reduction of the torsion, ileo-cecal resection is usually the best therapeutic alternative. Cecopexy may be appropriate in older and debilitated patients if there is no concomitant cecal necrosis.