Endoscopic retrieval of an impacted chicken bone in a sigmoid diverticulum

Abstract

, adynamic ileus and chronic constipation presumably related to hyperperistalsis, caecal displacement and colonic distension in anatomically susceptible patients. Intermittent caecal volvulus has been described in patients who have previously undergone caesarean section 6 and laparoscopic salpingectomy. 7 Our cases suggest that prior right oophorectomy may also be a risk factor, particularly as these patients did not have any symptoms prior to oophorectomy. Sometimes, division of the peritoneum around the right adnexa and gonadal vessels may require division of the peritoneal attachment at the caecal pole in the pelvis. Releasing the natural attachments of the ascending colon to the peritoneum inadvertently mobilizes the caecum and ascending colon. A low-lying caecocolic junction or an enlarged ovary may justify the need to dissect these attachments. Caecopexy has been suggested as a treatment option. 8 However, recurrence rate is high as seen in our second case. Right hemicolectomy provides a more definitive treatment approach. Our cases highlight the importance of avoiding division of natural peritoneal attachments around the caecum during pelvic surgery. If this operative step is necessary, reattachment of the caecum and ascending colon to the lateral abdominal wall should be advocated. Intermittent caecal volvulus should also be considered in this group of patients subsequently presenting with chronic right iliac fossa pain.