AB039. SOH24AB_062. Three twisted tales: a case series of caecal volvulus

Background: Caecal volvulus is the rotation or torsion of a mobile caecum and ascending colon. It represents a perilous aetiology of intestinal obstruction, with clinical manifestations spanning from intermittent abdominal discomfort to ischaemia, perforation and mortality. Risk factors include chronic constipation, atonic colon, Hirschprung’s disease and late-term pregnancy. Incidence is reported as between 2.8 and 7.1 cases per million per year internationally. Typically, patients have a history of prior similar episodes that resolve without medical intervention. Definitive treatment involves emergency right hemicolectomy while conservative management is associated with very high recurrence rates. Early detection allows for prompt intervention, resulting in reduced morbidity and mortality.

Methods: We report three cases of young adults (two male; one female; median age 43 years) who presented emergently over a two-year period with severe abdominal pain. All gave a history of prior investigations for similar, less severe episodes in the preceding years. Following clinical suspicion after thorough history and examination, computed tomography (CT)-scan confirmed the diagnosis of caecal volvulus.

Results: All three underwent emergency right hemicolectomy (2 laparoscopic, 1 open) with end-to-end anastomosis within three hours of admission. All experienced an uncomplicated perioperative course and were discharged home well at a median of six days post-operatively.

Conclusions: Caecal volvulus is uncommon, but its yearly incidence is increasing. Early detection and heightened clinical suspicion led to timely diagnosis; reducing morbidity and mortality. We report a case series of caecal volvulus, emphasising its presentation and highlighting the critical importance of early diagnosis.

Keywords: Acute abdomen; caecal volvulus; case series; intestinal obstruction; right hemicolectomy