Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Cecal volvulus is a type ofintestinal malrotationthat occurs in the lower part of the bowel. It can involve the cecum, terminal ileum, or colon.Cecal volvulusis not as common as other types of intestinal torsion, but all can lead to potentially serious bowel obstructions. Sometimes, people have recurrent, chronic symptoms before an acute torsion occurs. An acute blockage or twist in the bowel is a medical emergency that usually requires surgery.
Verywell / Jessica Olah
In some cases, the lower portion of the cecum does not firmly attach (or attach at all) during this period of fetal development. This allows the cecum to move freely (mobile cecum syndrome). Sometimes the condition is diagnosed during surgery or on a radiology film.
Many people would never realize they had a moveable cecum because they don’t experience any symptoms or problems.
Some circumstances or conditions can make it more likely a person who is predisposed will experience a problem related to mobile cecum, such as becoming pregnant, undergoing abdominal surgery, or getting an infection. Other factors, such as a high-fiber diet, may also play a role.
If a person does have symptoms of cecal volvulus, at first they may be intermittent, recurrent, and chronic. Eventually, they can culminate with an acute—and potentially serious—bowel obstruction. Many people develop an acute obstruction without having symptoms suggestive of a partial obstruction beforehand.
The symptoms resemble many other gastrointestinal conditions, which can make diagnosis difficult. Healthcare providers don’t see cases of cecal volvulus very often, especially compared to another type of intestinal torsion that affects the sigmoid colon (sigmoid volvulus). Therefore, a diagnosis of cecal volvulus may be missed or delayed.
When part of the intestine becomes twisted, the portion above the section continues to function. As food, fluid, gas, and stool moves through the bowel and reaches the folded or twisted part, a person will begin to feel unwell.
Symptoms of cecal volvulus include:
When the torsion has not lead to a completebowel obstruction, people may feel relief once they are able to pass gas—an indication that the volvulus has resolved on its own. When the obstruction cannot resolve itself, or complications have occurred, the pain and other symptoms will worsen.
If a person continues to experience recurrent episodes of cecal volvulus, complications can result even if an acute obstruction does not occur. When the bowel twists, its blood supply is cut off. Over time, repeated interruptions of normal blood flow to the same part of the intestine can cause the bowel to stop working.
Untreated cecal volvulus can also lead to potentially life-threatening infections, such as sepsis or gangrene,as the tissue dies (necrosis). As the pattern continues, symptoms may slowly get worse as the bowel loses its ability to function correctly. People may also experience worsening health related to malnutrition and malabsorption.
While cecal volvulus is not frequently seen inchildren, they are more likely to present with general symptoms such as fatigue, low energy, reluctance to eat, and vague belly pain.
Intestinal malrotation can also present in newborns—usually within the first month after birth. In these cases, male infants are more likely to show symptoms (which may at first be confused for colic). Cases that occur later in life seem to occur equally between males and females.
Cecal volvulus is quite rare, but there are certain conditions that can make a person more likely to develop it. As mentioned above, having a mobile cecum is a known predisposing factor in some cases. Around 10 percent of the population is estimated to have a cecum that is not properly attached—though this number may be low.
Many people never have symptoms and the condition is only noticed incidentally, if at all, during their lifetime. In fact, many cases are only noticed after a person has died and an autopsy is performed.
Other diseases and conditions that can lead to intestinal torsion include:
The majority of cases are diagnosed in older adult patients who are acutely ill or hospitalized—though not necessarily with bowel complaints initially. People who are elderly, chronically ill, or acutely ill with another condition that requires hospitalization are more at risk for complications if they develop cecal volvulus, including strangulation or perforation of the bowel.
Cecal volvulus is usually seen in adults of both sexes and all racial backgrounds who are between the ages of 30 and 60.The symptoms of cecal volvulus can be similar to other gastrointestinal conditions, such as appendicitis, irritable bowel syndrome, inflammatory bowel disease, and gastroenteritis (stomach flu).
If a person’s symptoms are recurrent, intermittent, and spontaneously resolve, rather than acute, it may take longer for them to be diagnosed. When the condition becomes acute, several types of imaging tests can be used to determine the cause.
In the emergency room, a practitioner will usually order a plain abdominal X-ray first to look for a bowel obstruction. Sometimes, a contrast enema may be administered so that different parts of the intestine are more visible on X-rays or other imaging, like a CT scan. This can help healthcare providers see where the obstruction is and figure out what might be causing it.
Other tests that might be ordered if a healthcare provider suspects a person has cecal volvulus include:
Surgery is necessary for most cases of cecal volvulus. However, the procedure a surgeon chooses will depend on the reason for the volvulus and the person’s state of health. In some cases, healthcare providers may want to try other methods to reduce the volvulus that don’t require surgery.
Treating cecal 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 cecal volvulus due to having a mobile cecum is likely to have repeated episodes of volvulus unless the section of unattached intestine is repaired.
If part of the intestine has stopped working or the tissue is strangled, it may need to be removed completely to prevent infection and help restore bowel function.
There are several surgical procedures that can be performed to treat cecal volvulus. A surgeon will choose the procedure they believe will have the best outcomes and lowest risk for each individual. When a person goes to the hospital and is diagnosed with acute cecal volvulus, elective surgery can usually be performed that day or very soon after the visit.
Surgical procedures that can be used to treat cecal volvulus include:
Sometimes, stomas are only temporary and another surgery can be performed later to reconnect the bowel. If this is successful, the stoma can be closed. If the bowel cannot be reconnected, a person will need to keep the stoma and wear an ostomy bag to ensure fecal matter can leave their body.
The surgeon will usually try 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 potential for complications and the amount of recovery time a person needs will depend on which type of surgery is performed.
In some cases, a healthcare provider may want to try more conservative treatment before surgery. This option is only possible in patients who are deemed medically stable and who do not have signs of bowel perforation or infection.
Non-surgical options for attempting to treat cecal volvulus include the decompression of the bowel via colonoscopy. This method is successful in untwisting the bowel in about 30 percent of cases; however, it is only a temporary measure and the intestine will usually twist or fold again.
Maurice Gibb’s Cause of Death Was a Bowel Obstruction
A Word From Verywell
Cecal volvulus is an uncommon cause of bowel obstruction that most often occurs in adults. Cases of cecal volvulus can be recurrent (come and go) and resolve spontaneously on their own, but they may also be or become acute and lead to a partial or complete bowel obstruction.
While there is no definitive course of treatment, most patients will need to have surgery, particularly if part of their intestine has become damaged due to repeated episodes of cecal volvulus. Be sure to discuss your options with your healthcare provider who should be able to evaluate the best options for you based on your individual needs.
What Is an Ostomy?
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johns Hopkins Medicine.Understanding an Intestinal Obstruction.Consorti ET, Liu TH.Diagnosis and treatment of caecal volvulus.Postgrad Med J.2005;81(962):772-6. doi:10.1136/pgmj.2005.035311Cleveland Clinic.Large Bowel (Intestinal) Obstruction.Hasbahceci M, Basak F, Alimoglu O.Cecal volvulus.Indian J Surg. 2012;74(6):476–479. doi:10.1007/s12262-012-0432-9American Pediatric Surgical Association.Cecal Volvulus.Garude K, Rao S.Mobile cecum: an incidental finding.Indian J Surg. 2013;75(4):265–267. doi:10.1007/s12262-012-0529-1University of California San Francisco Center for Colorectal Surgery.Volvulus (Twisting of the Colon).
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johns Hopkins Medicine.Understanding an Intestinal Obstruction.Consorti ET, Liu TH.Diagnosis and treatment of caecal volvulus.Postgrad Med J.2005;81(962):772-6. doi:10.1136/pgmj.2005.035311Cleveland Clinic.Large Bowel (Intestinal) Obstruction.Hasbahceci M, Basak F, Alimoglu O.Cecal volvulus.Indian J Surg. 2012;74(6):476–479. doi:10.1007/s12262-012-0432-9American Pediatric Surgical Association.Cecal Volvulus.Garude K, Rao S.Mobile cecum: an incidental finding.Indian J Surg. 2013;75(4):265–267. doi:10.1007/s12262-012-0529-1University of California San Francisco Center for Colorectal Surgery.Volvulus (Twisting of the Colon).
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Johns Hopkins Medicine.Understanding an Intestinal Obstruction.Consorti ET, Liu TH.Diagnosis and treatment of caecal volvulus.Postgrad Med J.2005;81(962):772-6. doi:10.1136/pgmj.2005.035311Cleveland Clinic.Large Bowel (Intestinal) Obstruction.Hasbahceci M, Basak F, Alimoglu O.Cecal volvulus.Indian J Surg. 2012;74(6):476–479. doi:10.1007/s12262-012-0432-9American Pediatric Surgical Association.Cecal Volvulus.Garude K, Rao S.Mobile cecum: an incidental finding.Indian J Surg. 2013;75(4):265–267. doi:10.1007/s12262-012-0529-1University of California San Francisco Center for Colorectal Surgery.Volvulus (Twisting of the Colon).
Johns Hopkins Medicine.Understanding an Intestinal Obstruction.
Consorti ET, Liu TH.Diagnosis and treatment of caecal volvulus.Postgrad Med J.2005;81(962):772-6. doi:10.1136/pgmj.2005.035311
Cleveland Clinic.Large Bowel (Intestinal) Obstruction.
Hasbahceci M, Basak F, Alimoglu O.Cecal volvulus.Indian J Surg. 2012;74(6):476–479. doi:10.1007/s12262-012-0432-9
American Pediatric Surgical Association.Cecal Volvulus.
Garude K, Rao S.Mobile cecum: an incidental finding.Indian J Surg. 2013;75(4):265–267. doi:10.1007/s12262-012-0529-1
University of California San Francisco Center for Colorectal Surgery.Volvulus (Twisting of the Colon).
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