LAUSR

volvulus: (1) An abnormally mobile segment of cecum and colon (2) A fixed point around which the mobile segment can twist. The latter condition is created through normal ileocolic attachments, as well as through abnormal adhesions after surgery. Other risk factors include pelvic masses and pregnancy. In pregnancy, as the uterus enlarges, it raises any redundant or abnormally mobile caecum out of the pelvis, helping to explain why the most common occurrence of a volvulus is in the third trimester of pregnancy. Did this patient always have a caecal volvulus or did she develop this post-operatively due to the mobilization of the ascending colon at appendicectomy? This patient’s presentation is consistent with that of other case studies in pregnant women with caecal volvulus. However, no abnormality of the caecum was detected on USS and magnetic resonance imaging preoperatively and no volvulus was identified at initial operation. It seems likely that the volvulus occurred because the caecum was brought out of the pelvis, and made abnormally mobile intraoperatively. A review of the literature did not reveal any prior case reports of caecal volvulus post-appendicectomy in pregnancy; however, there is a case report of caecal volvulus post-laparoscopic appendicectomy in a nonpregnant patient. Interestingly, in that case, the ascending colon was also mobilized intraoperatively. This case highlights that if the caecum is mobilized during appendicectomy, especially in a pregnant lady, volvulus may result if proper positioning of the caecum is not restored before closing. A caecopexy may need to be considered in these situations.