Journal Article

Caecal Volvulus after a dental procedure – not just constipation!

Ng, ZQ, Tan, HCL, Tan, JH

2019

Overview

Any segment of the colon can be affected by volvulus; however, sigmoid is most commonly affected (60-75%), followed by the caecum (25-40%), transverse colon (1-4%) and splenic flexure (1%).1 Various rare associations of caecal volvulus have been made with abdominal/ pelvic pathologies such as bowel cancer, acute cholecystitis, abdominoplasty, pregnancy, ventral hernia, endometriosis and uterine leiomyoma.1,2 Herein, we present a case of large bowel obstruction from caecal volvulus which was likely precipitated by the use of an opioid for analgesia after a dental procedure, highlighting the importance of thinking out-of-the-box and not just zeroing in on constipation. With the background history of chronic constipation in the current case, the use of an opioid prolongs the colonic transit time, which may have been the precipitating factor for the colonic volvulus.3 An anatomical predisposition has been noted where there is a lack of parietal fixation of the ileocaecal region during embryological counterclockwise caecal rotation from the left side of abdomen towards the right iliac fossa.1 As a result of the embryological predisposition, caecal volvulus maybe part of the spectrum of conditions that includes mobile right colon. Key CT findings of caecal volvulus include the \"CT coffee bean,\" \"bird beak\" and \"whirl sign\" (Figure 2b).1 Surgical options for caecal volvulus include singlestage primary ileo-colic resection and anastomosis or a two-staged procedure with delayed ileo-colic anastomosis following a period of temporary double-barrelled stoma.

• Publisher: Academy of Family Physicians of Malaysia,Academy of Family Physician of Malaysia
• Subject: Abdomen / Case Report / Colon / Constipation / Family medical history / Fibroids / Mesentery / Mortality / Narcotics / Pain / Patients / Tomography