[Cecum volvulus--a frequently misdiagnosed disease picture. Results of a retrospective study of 26 patients and review of the literature].

BACKGROUND: Cecal volvulus represents a rare disease which causes acute or chronic intermittent mechanical obstruction. Diagnosis of the acute form of cecal volvulus is often established too late with resulting high morbidity and mortality. This study characterizes the typical clinical symptoms, radiological signs and the frequent concomitant diseases, based on a rather large number of patients. We specifically evaluated possible differences concerning clinical presentation, therapy and postoperative course of patients with vital bowel as opposed to necrotic cecum. PATIENTS AND METHODS: 26 consecutive patients hospitalised with cecal volvulus from January 1984 until February 2000 were retrospectively evaluated. Patients with vital intestine (n = 14) were compared to those with necrotic cecum (n = 12).
RESULTS: 38% of patients underwent previous abdominal surgery, 34% suffered from other acute disease, in 38% cecal volvulus was associated with a neuropsychiatric disorder. 58% of the patients showed symptoms of intestinal obstruction. The clinical pattern of patients with necrotic cecum was not significantly different from those of patients with vital intestine. Diagnosis of cecal volvulus could be established in 77% by plain abdominal X-ray alone or by an additional contrast enema.
CONCLUSIONS: Knowledge of the characteristic pattern of history, physical findings, plain abdominal X-ray and the frequently with cecal volvulus associated diseases most often allows to establish diagnosis of cecal volvulus without delay and other diagnostic procedures. Astonishingly we found no major difference between vital and necrotic cecum with regard to clinical presentation and postoperative course.