Evidence‑Based Surgical Management of Cecal Volvulus

Epidemiology and Presentation

• Approximately 5 %–25 % of patients with cecal volvulus present with colonic ischemia, perforation, or peritonitis, necessitating immediate operative intervention. 1

Timing of Surgery

• Emergency surgery is mandatory for all cecal volvulus cases because the condition can rapidly progress to gangrene and markedly increase mortality once necrosis develops. 2

Intra‑operative Assessment and Technique

• During exploration, bowel viability must be carefully evaluated; if ischemia is identified, resection without prior detorsion is recommended to minimize endotoxin release and the risk of perforation. 1
• Indocyanine‑green fluorescence imaging may be employed when perfusion assessment is uncertain (optional adjunct, not tied to a specific citation).

Choice of Reconstruction

• Primary ileocolic anastomosis is the preferred reconstruction when the patient is hemodynamically stable and the bowel ends are viable. 1
• End ileostomy (or other stoma creation) is indicated in any of the following situations:
  
  • Hemodynamic instability,
  • Significant peritoneal contamination,
  • Presence of prohibitive comorbidities (e.g., high ASA score, coagulopathy, acidosis, hypothermia).

Endoscopic Detorsion – Ineffective Strategy

• Colonoscopic detorsion of cecal volvulus has a very low success rate and should not be attempted; success rates are markedly lower than the 60 %–95 % achieved in sigmoid volvulus. 2

Risk of Undetected Ischemia

• Bowel ischemia may be present even when peritoneal signs are absent; cecal volvulus can swiftly evolve to gangrene, and mortality rises substantially once necrosis occurs. 2

Surgical Management of Cecal Volvulus

Immediate Surgical Intervention

• Immediate operative treatment with right hemicolectomy and primary ileocolic anastomosis is required for patients with cecal volvulus; endoscopic detorsion has no therapeutic role. 3

Endoscopic Detorsion Contraindicated

• Colonoscopic (endoscopic) detorsion of cecal volvulus is ineffective and should not be attempted because it delays definitive surgical management. 3