This terminology is a diagnosis of surgical urgency that demands immediate surgical intervention. In its absence practitioners are mislead into awaiting "a nothing " and missing the diagnosis of a colonic torsion in process. I have not yet seen an actual photograph of a bona fide Cecal Volvulus The published photographs are cecal bascules or cecocolic torsions of various morphology in acute or chronic stages with the area of torsion at the ascending colon but depicting a normal ileum. The pencil or ink illustrations are eidetic extensions of imaginative interpretation of the x-ray pictures, e.g. whirl sign which depict torsion lines, I very much want to believe that it exist. Is there someone out there with a photograph proving that it exists .....for the edification of the medical world?
dear dr francisco
normally volvulus happens when the mess of colon is long and free and in empty colon,and as you know the cecum is adhered to retroperiton with short meso. so we cannot expect a cecum volvolus unless as a anatomical variation
Dear Doctor Mahmoodzadeh: Thank you for responding. The incidence of the absence of fixation of the cecocolon is approximately 30% because of failure of the 3rd stage of embryologic development of the colon. The cecum alone is unfixed in 19.2% ( Wolfer et. al.1941). The cecum is wider than long, and it can swing but it can not twist 360 degrees to form a volvulus. This term Cecal Volvulus is a misnomer and an anatomical impossibility. The only photograph I have ever seen is in Cameron's Current Surgical Therapy, Seventh Edition, page 202. and here the cecum is normal, the torsion is at the ascending colon and the ileum looks normal. I saw an actual duplicate of this in my practice and published it recently labeled as Acute Cecocolic Torsion, Fig.2, in Congenital Hyperrotation of the Colon; Abdominal Surgery, Winter/Spring 2015 issue. The symptomatic cecocolic torsion is estimated to be about 0.5% ( Appendicitis is 9 to 10%). There are many undiagnosed cases because we await an acute organic entity of high surgical urgency and not an organ in recurring process of torsions with spontaneous resolutions. I hope that someone, somewhere out there, in this worldwide forum, can prove its existence because in the meantime many out there suffering from their pain that can not be stilled.
