What is the consensus on the morbidity, if any, and treatments recommended.
During 40 y. practicing gastroenterology I have never seen any consequence of overrotation of colon. If present, symptoms have always be ascribed at an other cause.
The only consequence has be atypical presentation of appendicitis.
Hyperrotation (overrotation) of the colon results in nonfixation of the cecum and ascending colon and imbues it with mobility. They have the propensity for torsion. The cecum may seesaw and fold upon itself termed a " cecal bascule" and the ascending colon may torse. Both may result in acute or recurrent partial or complete obstruction .They have been loosely and mistakenly called Cecal Volvulus. The term Floppy cecum syndrome has also been invoked . Colonoscopy in nondiagnostic but can be used to detorse a cecocolic torsion. Symptomatic patients have been misdiagnosed, undiagnosed, and called psychotic for persistently requesting relief. Symptomatic hyperrrrotated cecocolon is a fact. It may be seen by a plain film of the abdomen and confirmed specifically with a positional contrast enema. Contrast can also be used to detorse the cecocolon. My surgical correction depending upon the variant involved was Cecopexy, Cecopexy with cecostomy, right segmental or right Colectomy. Those who went for negative Appendectomies, Irritable bowel syndrome, Ogilvie's syndrome, etc were innocently sidetracked by unmeasured experiences and opinions by consensus. I fact, to this day, physicians out there still invoke the diagnosis of "Cecal Volvulus"(?) which is nonexistent..
I posed the query because this problem has been conveniently ignored by the medical community and there are patients suffering out there.. There is still no discussion or consensus about nuanced presentations and I was hoping for such. For your information my email is [email protected] if you want to communicate directly. You may brouse the publications: (1).Cecocolic Torsion, Clinical diagnosis and treatment, JSLS, July 2005, (2) Recurrent Cecocolic Torsion: Radiological Diagnosis and treatment, JSLS , April 2003. (3). etc. See bibliography for more.
I am hoping for any out there who may have had the same experience as I had and have differing opinion on what best to do for these cases.
Right-sided colonic volvulus is the consequence of a lack of fixation and not of over rotation per se.
Colonoscopic detorsion is much more difficult and dangerous than for sigmoid and by no means a routine procedure.
Chronic consequences of over rotation are questionable.
To opine that congenital Hyperrotation of the colon has no "chronic consequence", if you have no experience about, is very untenable. The absence of information to edify you does not mean the absence of a disease entity. You cite only a diagnosis of high expectancy, a completed torsion, but... can this diagnosis occur only in an emergent episode without previous subacute presentation? And those having chronic recurrent attacks of pain with varying intensity who were missed diagnosis or never diagnosed in their lifetimes? Shall we ignore them because they were not written up anywhere? I have been seeing these cases for the past 33 years.The last case I helped diagnose and treat was about a year and a half ago and I have the Barium enema film and her letter of thanks.
Two prominent developmental defects of the right colon are:1. Rotational (a) Malrotation with Ladd's Band (b) Normal rotation without fixation (c) Hyperrotation obligatorily without fixation. I agree that the lack of fixation ( 3rd stage developmental defect) of the normally rotated and the over-rotated colon allows, not cause per se, the cecocolon to torse. These may be facilitated by a fulcrum of Jackson's or Parietocolic membrane. I have never seen in reality or in pictures (not eidetic overreach sketches) a completed 360 degree torsion or volvulus of the "right sided" colon that has to and must involve also the ileum an Ileo-cecocolic volvulus although it is possible.
As a friendly bet, I have a hundred dollars against the hole in your doughnut that you can not supply me with a photograph of it. If you have a picture of it, please email me an attachment but, for proof, I can snail mail or email you photographs of torsion of the right colon with a normal ileum and ascending colonic segment, CT scan, Barium and gastrografin enemas, Cecocolic psedotumors , phantom tumors, pseudocysts, etc. I do not have a photograph of a cecal volvulus because it does not exist !
The so called " Volvulus", being an end diagnosis of high emergency ends up being resected by the surgeon, so it is hardly seen on out patient consultation basis . The infrequently symptomatic patients are those with baffling recurrent pains or masses at the RLQ, normal appendectomies, hysterectomies, oophorectomies, dyspareunias, IBS, Ogilvies,, Incarcerated left inguinal hernias, Amyands appendix, Phantom Tumors, undiagnosed pelvic cysts on ultrasound, etc.etc. .and those unreported by our friendly radiologists who commonly see them.
I have "read and heard" about detorsion by colonoscopy but I have no hands on experience. This maneuver would demand judgement and craftsmanship . We have prudently reduced some with gastrografin and barium then eventually cecofixed or resected them. Detorsion is temporarily remedial specially those with comorbidity.
See : F.T.Tirol; Congenital Hyperrotated Colon, Abdominal Surgery, Winter/Spring, 2015; 11-17
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