A 55-year-old patient presents to the emergency department with abdominal pain, distension, and vomiting. Imaging confirms a diagnosis of cecal volvulus. Which of the following risk factors is responsible for 50–70% of cecal volvulus cases?

1. A

   A. High-fiber diet

2. B

   B. Lactulose abuse

3. C

   C. Female sex

4. D

   D. Previous abdominal surgery

Appeared in: INI-CET EXAM -2026

Explanation

• Previous abdominal surgery is the leading cause of intra-abdominal adhesions.
• Adhesions are fibrous bands of scar tissue that can form after surgery, tethering organs and tissues that are normally separate.
• The cecum is a relatively mobile part of the large intestine. An adhesion can act as a fixed pivot point.
• This fixed point allows the mobile cecum to twist upon itself, leading to a volvulus and subsequent bowel obstruction.
• Literature confirms that postoperative adhesions are responsible for the majority (>50%) of mechanical small and large bowel obstructions.

Why Other Options Were Wrong

• Option A: A high-fiber diet is generally recommended for bowel health and to prevent constipation. It does not create the anatomical abnormality required for a volvulus to occur.
• Option B: Lactulose is an osmotic laxative. While its abuse can lead to diarrhea, dehydration, and electrolyte imbalances, it does not cause the mechanical twisting of the bowel seen in volvulus.
• Option C: While some gastrointestinal conditions have a sex predilection, cecal volvulus is not predominantly associated with the female sex to the extent that it would be considered a primary risk factor.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Risk factors for cecal volvulus in acute care settings.
• A key nursing responsibility is obtaining a thorough patient history, including all past surgeries. For a patient presenting with an acute abdomen, a history of abdominal surgery immediately raises the suspicion of an adhesion-related obstruction.
• Nurses must monitor postoperative patients for signs of bowel obstruction, including abdominal distension, nausea, vomiting, and changes in bowel sounds or function. Early detection is critical.
• What if? If the patient had no history of abdominal surgery, other risk factors for volvulus would be considered, such as chronic constipation, a high-fiber diet in a region with a long colon (dolichocolon), or congenital malrotation, although these are less common causes for cecal volvulus compared to adhesions.

How to Approach the Question

• First, identify the key concept in the question: the single most significant risk factor for cecal volvulus, responsible for 50-70% of cases.
• Analyze the clinical presentation: abdominal pain, distension, and vomiting are classic signs of bowel obstruction.
• Evaluate the options based on pathophysiology. A volvulus is a mechanical problem (a twist).
• Consider what could cause a mobile part of the bowel, like the cecum, to twist. A fixed point or an abnormal attachment is a likely cause.
• Recall or deduce that abdominal surgery is the most common reason for abnormal attachments (adhesions) to form within the abdomen.
• Compare this strong mechanical cause to the other options (diet, medication, sex), which are less likely to cause a physical twist. This points to previous abdominal surgery as the most probable answer.

Concept Tested & Keywords

• Concept Tested: Risk factors for cecal volvulus
• Stem keywords: cecal volvulus, risk factors, abdominal pain, distension, vomiting
• Lead-in keywords: responsible for
• Clinical cues: Patient with confirmed cecal volvulus

Question ID

QE-vxrduKe7gJycFbl20of

Copy ID

Reference Book

E6 Gynecology Williams p. 58-81

E6 Medicine Harrison 22e Part 2 p. 494-496