EP 375 Caecal Volvulus Presenting Ten Years after Appendicectomy: A Rare Case Report

Abstract

Caecal volvulus is uncommon, with an incidence of approximately 2.8–7.1 cases per million population per year. Predisposing factors include congenital absence of retroperitoneal fixation of the right colon, distal colonic obstruction, pregnancy, chronic constipation, and excessive peristalsis. Caecal volvulus following appendicectomy is rare and is thought to relate to the development of an acquired mobile caecum.

We present the case of a 48-year-old female who presented with acute abdominal pain and coffee-ground vomiting. She was previously fit and well, with a background history of asthma, and had undergone an appendicectomy in 2015. A computed tomography scan demonstrated caecal volvulus, with displacement of the caecum into the left upper quadrant and associated upstream small bowel dilatation. The patient was resuscitated and taken urgently to the theatre for operative management.

Intraoperatively, a caecal volvulus was identified with a bruised caecum in the left upper quadrant, along with infra-umbilical adhesions and free intraperitoneal fluid. A limited right hemicolectomy was performed with a side-to-side isoperistaltic stapled anastomosis. The postoperative course was uneventful, and histology demonstrated early acute-on-chronic ischaemic colitis consistent with caecal volvulus.

Although rare, prior appendicectomy is an important aetiological factor to consider in patients presenting with caecal volvulus, particularly when imaging demonstrates an unusual caecal position such as the left upper quadrant. The delayed presentation in this case, occurring ten years after the index operation, highlights the long-term risk of an acquired mobile caecum. Awareness of this potential late complication is important for both surgeons and patients.