Laparoscopic assisted right hemicolectomy for caecal volvulus

Acute caecal volvulus is an uncommon cause of the acute abdomen and the diagnosis may not be immediately apparent. It presents with abdominal pain, vomiting and abdominal distension. Laparoscopy is still somewhat controversial for bowel obstruction and the case reported herein is presented to show the advantage of laparoscopy for caecal volvulus.A 57-year-old woman was admitted to hospital with several days of abdominal pain, vomiting, abdominal distension and constipation. She had suffered for two years with intermittent bouts of colicky abdominal pain and loose bowels, which previously had been diagnosed as irritable bowel syndrome, although no investigations had been done.On examination she was febrile and tachycardic with abdominal distension and tenderness. Blood tests showed a raised white cell count and abdominal x-rays showed dilated loops of small bowel with a dilated loop of large bowel in the left upper quadrant (figure 1). Although caecal volvulus was suspected, a Gastrografin enema (Schering AG, Germany) was done to confirm the diagnosis while operation was arranged (figure 2).The pneumoperitoneum was carefully established after open insertion of a 10 mm cannula through the umbilicus and subsequently two 5 mm ports were added. The tense, distended caecum was visible in the left upper quadrant and there was dilated small bowel and collapsed colon (figure 3). A 25G spinal needle was inserted through the anterior abdominal wall into the caecum. It was connected to a 10 ml syringe barrel and suction tubing, which was connected to wall suction (figure 4). The caecum was rapidly deflated and it was viable although there was a large serosal tear (figure 5). The caecum was flipped back to be in a more normal position and the umbilical port side was enlarged. The caecum and terminal ileum were delivered and a limited right hemicolectomy was performed with end-to-end anastamosis of terminal ileum to ascending colon with interrupted 3-0 Vicryl (Ethicon, New Jersey