Cecal Volvulus

In the OR

Define viability before reconstruction.

Identify the torsion or cecal bascule and the degree of right-colon mobility
Assess the cecum, terminal ileum and proximal right colon for ischemia, gangrene or perforation
Resection is favored because simple detorsion or fixation has meaningful recurrence risk
Avoid aggressive manipulation of frankly gangrenous bowel before vascular control/resection when this may worsen contamination or physiologic insult
Choose primary anastomosis versus diversion according to contamination, perfusion and the patient's physiology

After the OR

Continue resuscitation and monitor for sepsis, ileus, leak and ongoing organ dysfunction.
When bowel viability was uncertain or physiology was severely deranged, planned reassessment/second look may be appropriate.
Advance nutrition according to gastrointestinal recovery and overall stability.
Document the cause and extent of resection because recurrence risk is essentially addressed by removal of the mobile segment.