A 45-year-old woman presents with acute onset right iliac fossa pain, vomiting and distension. Radiographs show a large gas-filled viscus in the upper abdomen and a paucity of gas in the rest of the colon. At laparotomy the cecum is twisted and viable. What is the correct operation?
- A Right hemicolectomy with primary ileocolic anastomosis ✓
- B Detorsion with cecopexy alone
- C Detorsion with appendicectomy only
- D Colostomy and closure of the defect
Correct answer: A. Right hemicolectomy with primary ileocolic anastomosis
Explanation
Cecal volvulus differs from sigmoid volvulus because endoscopic reduction is rarely successful and recurrence is common. Even when the cecum appears viable at operation, the definitive treatment is right hemicolectomy with primary ileocolic anastomosis, since simple detorsion carries a high recurrence rate and cecopexy alone has significant failure rates. This reflects the mobility of a congenitally unfixed cecum, which allows axial torsion around the ileocolic pedicle.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.