A 45-year-old woman presents with acute onset colicky right iliac fossa pain and vomiting. CT shows the caecum rotated anterosuperiorly with a dilated gas-filled loop in the right upper quadrant and a whirl sign of the mesentery. There are no signs of ischaemia. What is the definitive management?

• A Colonoscopic reduction followed by fixation caecopexy
• B Right hemicolectomy without primary anastomosis
• C Caecostomy with tube decompression
• D Right hemicolectomy with primary ileocolic anastomosis ✓

Explanation

Caecal volvulus requires operative management because endoscopic reduction is rarely successful and risks perforation. In a viable non-ischaemic caecum, right hemicolectomy with primary ileocolic anastomosis is the definitive treatment, eliminating the mobile caecum and its mesentery that caused the torsion. Caecopexy and caecostomy have high recurrence and morbidity and are largely abandoned. Resection without anastomosis is reserved for gangrenous or perforated bowel in unstable patients.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.