Acute caecal volvulus during a 90 km ultramarathon: A case report

Background: Caecal volvulus is an uncommon cause of large bowel obstruction that occurs in patients with a congenitally mobile caecum. It is rarely reported in association with endurance exercise. Objectives: To describe an acute caecal volvulus precipitated during a 90 km ultramarathon and to highlight the diagnostic and management considerations relevant to sports and exercise medicine. Case: A 51-year-old female runner developed acute severe right-sided abdominal pain and vomiting while running the Comrades Marathon. Contrasted computed tomography demonstrated a markedly distended caecum consistent with caecal volvulus. She underwent emergency laparotomy, right hemicolectomy and ileocolic anastomosis. A transient rise in troponin with a structurally normal echocardiogram was attributed to demand ischaemia. She recovered uneventfully. Conclusion: Caecal volvulus should be considered in an endurance athlete presenting with acute right-sided abdominal pain. Early cross-sectional imaging and prompt surgery are key to a good outcome.