Synopsis
Diagnose a displaced or folded caecum, recognise its risk of infarction, and choose timely resection and reconstruction without borrowing the sigmoid detorsion pathway.
- Caecal volvulus usually requires urgent surgery; colonoscopic detorsion has low success and can delay treatment or perforate the bowel.
- A displaced distended caecum with a transition and mesenteric twist on CT identifies a mechanical problem, even when the small bowel is also dilated.
- Peritonitis, deteriorating perfusion or reduced bowel enhancement requires immediate assessment for infarction and operative source control.
Key red flags
Progressive focal tenderness, guarding, fever, tachycardia or shock raises concern for gangrene or perforation. Reduced enhancement, free gas or concerning fluid on CT adds weight. Do not wait for all of these features to coexist before involving the operating surgeon.
Investigation priorities
Locate the caecum, define the obstruction and assess threatened bowel.
Management branches
Imaging or operative assessment identifies symptomatic caecal volvulus or bascule.
- Contact the emergency surgical team, maintain nil-by-mouth care and begin resuscitation. Peritonitis, suspected necrosis or perforation calls for urgent source control, with appropriate intravenous antibiotics when contamination or sepsis is suspected.
- Prepare for surgery rather than routinely attempting colonoscopic detorsion. The caecal location, low success of endoscopy and risk of perforation make the sigmoid endoscopic pathway unsuitable.