"As little barium as possible should be allowed to flow proximal to the site of obstruction because flooding the bowel proximal to the obstruction site might precipitate a complete obstruction. When the barium enema is administered, overdistension should also be avoided because this can lead to perforation. An attempt should always be made to reduce the volvulus. This reduction may be achieved during colonic filling by barium, but reduction occasionally occurs during barium evacuation. With an intermittent volvulus, the barium enema results may be normal, but a post-evacuation radiograph may reveal the twist."
"Colonoscopic decompression may be appropriate if the patient is unfit for surgery. However, laparotomy is normally required. Where there is colonic ischaemia, a right hemicolectomy is performed; in some cases, the primary anastomosis is not possible, and stoma formation at both ends is the safest option."
Expected headings
"Fluoroscopy"
"Contrast enema"
"Caecal volvulus accounts for ~10% of all intestinal volvuluses, and generally occur in somewhat younger patients than with sigmoid volvulus, most being 30-60 years old. There are two predisposing factors that are important for the development of a caecal volvulus 5:"
"There is a variant of caecal volvulus termed a "caecal bascule" that occurs when the caecum folds anteriorly without any torsion. A caecal bascule is often seen as a dilated loop in the mid-abdomen and although there is an association with prior surgery, adhesions, and bands they are not essential for a volvulus to occur. In 10% of the population, there is a deficient peritoneal fixation of the caecum and ascending colon allowing abnormal mobility. Depending on the length of the mobile segment of right colon a variety of obstructive bowel patterns may result."
"Medical history of these patients may include prior abdominal surgery, the presence of a pelvic mass, violent coughing, atonia of the colon, extreme exertion, unpressurised air travel, or third-trimester pregnancy."
"Colonoscopic decompression may be appropriate if the patient is unfit for surgery. However, laparotomy is normally required. Where there is colonic ischaemia, a right hemicolectomy is performed; in some cases, the primary anastomosis is not possible, and stoma formation at both ends is the safest option."