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Volvulus of the cecum and ascending colon is not as rare as is generally assumed. The early recognition of this type of colonic obstruction is of great importance for radiologist and surgeon alike. The radiologist can make the diagnosis correctly in many instances, and on this basis the surgeon is guided to proper remedial procedures and, eventually, to prevention of a recurrence of such an accident.

Bundschuh (7) collected 110 cases of cecal volvulus in 1913. For the period 1913–42, Wolfer, Beaton, and Anson (63) collected 194 cases, bringing the total to 304. Courty (11) cites an additional 75 examples from France since 1940, and a review of the readily available sources in the American and British literature since 1942 has yielded 68 cases. To these we are adding 24 new cases, 19 of which were seen in a three-year interval, making a total of 471.

Volvulus of the cecum and ascending colon represents a type of mechanical obstruction of the proximal half of the colon, presupposing inadequate fixation of a variable length of the right colon complicated by pathologic degrees of rotation and displacement. The severity of obstruction varies greatly, depending on the extent and degree of torsion, displacement, and tension permitted to develop (time factor).

While the consensus of opinion as expressed in the literature is that a preoperative diagnosis of volvulus of the cecum and ascending colon is seldom made, the possibility of accurate diagnosis by radiographic means has been mentioned (5, 11, 12, 24, 43, 44, 51, 52, 58, 63).

Anatomical Consideration

All modern writers agree that volvulus of the cecum is dependent on the failure of the primitive mesentery to become adherent to the posterior abdominal wall. During its embryologic development the cecum assumes its normal position in the right iliac fossa by the operation of three processes: rotation, which carries the originally left-sided colon across the abdomen; descent, as a result of which the cecum sinks from a subhepatic position into the right iliac fossa; fixation, whereby the right mesocolon is obliterated and the right colon becomes adherent to the posterior wall of the abdomen. A mobile right colon represents an anomaly of fixation, the degree of mobility depending on the extent of the mesenteric attachment.

On the basis of 125 anatomic dissections, Wolfer et al. stress that not only must hypofixation (persistent common mesentery; imperfect fixation) of an adequate degree be present, but that some degree of hyperfixation of the ileum, cecum, or ascending colon is essential for the occurrence of volvulus. The point of fixation acts as a fulcrum on which the mobile segment can rotate, and its location will determine the length of right colon involved as a result of torsion. It may therefore be the principal factor determining the appearance and location of the twisted bowel and will partially account for the variability in the roentgenographic appearance.

Article History

Accepted: Oct 1952
Published in print: Oct 1953