V15 - Emergent Robotic Ileocecectomy for Cecal Volvulus: Expanding the Role of Robotics in Acute Care Colorectal Surgery

CME Eligible

Purpose/Background: Cecal volvulus is a rare but life-threatening cause of large-bowel obstruction, accounting for approximately 1-1.5% of all intestinal obstructions and 10-15% of colonic volvulus cases. It results from torsion of a mobile cecum and ascending colon around the mesenteric axis, often leading to bowel ischemia or perforation if untreated. According to the ASCRS Clinical Practice Guidelines (2016), endoscopic detorsion is not recommended due to its low success rate and high perforation risk. Definitive management consists of segmental resection with primary anastomosis in patients with viable or nonviable bowel who are fit for surgery. This case highlights the feasibility of a robotic approach in the emergent management of cecal volvulus.

Methods/Interventions: A 41-year-old male presented with a 3-hour history of severe right-lower-quadrant abdominal pain. CT imaging revealed a markedly dilated cecum (8.4 cm) with mesenteric swirling consistent with cecal volvulus. The patient was taken emergently to the operating room for definitive managment. Intraoperatively, the cecum was detorsed and found to be distended with a wide serosal tear but without perforation or ischemia. An ileocolic resection was performed using the Robotic Xi system with a primary intracorporeal anastomosis.

Results/Outcomes: Operative time was 120 minutes with minimal blood loss. The patient tolerated diet on postoperative day 1, mobilized early, and was discharged on postoperative day 2 without complications.

Conclusion/Discussion: This case illustration demonstrates that robotic ileocecectomy is safe, effective, and guideline-consistent for the management of cecal volvulus. The robotic platform provides superior visualization and dexterity, supporting rapid recovery, low morbidity, and early discharge despite severe bowel distension. This experience underscores the expanding role of robotic surgery in care of colorectal emergencies, bridging minimally invasive precision with urgent surgical needs.