A 25-year-old woman presents with sudden colicky central abdominal pain, vomiting, and a palpable smooth mass in the right iliac region. CT shows a dilated, fluid-filled cecum displaced toward the epigastrium with a mesenteric whirl sign in the right lower quadrant. There are no signs of bowel ischemia on imaging. What is the treatment of choice?
- A Right hemicolectomy with primary ileocolic anastomosis ✓
- B Endoscopic decompression followed by cecopexy
- C Barium enema reduction and observation
- D Colonic stenting across the volvulus
Correct answer: A. Right hemicolectomy with primary ileocolic anastomosis
Explanation
Cecal volvulus results from a mobile, incompletely fixed cecum and typically affects young women. Unlike sigmoid volvulus, it responds poorly to endoscopic decompression, and recurrence after simple detorsion or cecopexy is high, so right hemicolectomy with primary ileocolic anastomosis is the standard treatment even without established gangrene. Endoscopic decompression is unreliable here because the twist involves the cecum and ascending colon rather than a long redundant sigmoid loop.
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.