Management of cecal volvulus in adolescents: a case series

Abstract

Introduction

The incidence of cecal volvulus in the pediatric population is unknown and there is no consensus on the best approach to managing in children.

Case presentations

Case 1: A 17-year-old female presented with one day of abdominal pain and tenderness in the right lower abdomen. Laboratory studies were notable for leukocytosis. A computed tomography scan of the abdomen and pelvis (CT-A/P) demonstrated a swirl of the right colonic mesentery, consistent with cecal volvulus. Laparoscopic detorsion was performed via three ports. The lateral peritoneal attachments were found to be redundant. The peritoneum near the colon was sutured to its attachment to the lateral abdominal wall, to shorten the attachments of the right colon in an interrupted fashion with non-absorbable suture at three points. An appendectomy was performed and the base, rather than the cecum, was fixated to the lateral abdominal wall. The patient was discharged on postoperative day one. On follow-up one week later, she was doing well and there were no concerns.

Case 2

A 17-year-old female presented to an outside hospital with several hours of abdominal pain, associated nausea, and tenderness in the right lower abdomen. Laboratory studies were unremarkable. A CT-A/P demonstrated a swirl of the right colonic mesentery and cecal dilation of 9 cm, consistent with cecal volvulus. The patient was then transferred to our facility for definitive care. Management was via an open approach and revealed a lack of right colon peritoneal attachments. An ileocecectomy was performed followed by a primary stapled ileocolic anastomosis. The patient recovered well and discharged home on postoperative day three. There were no reported concerns at follow-up six weeks later.

Conclusion

Cecopexy and ileocecectomy may have similar outcomes for the management of cecal volvulus in adolescents.