Cecal Volvulus: Report of a Case

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A rare case of cecal volvulus that was preoperatively diagnosed and surgically treated is herein reported. An 85-year-old woman was admitted to our hospital because of abdominal pain and distension concomitant with nausea and vomiting. She had no past history of laparotomy. Her abdomen showed distention with muscle rigidity and positivity for Blumberg's sign. Plain abdominal X-ray showed a markedly air-distended bowel segment in the right lower abdomen associated with dilated small intestine. An abdominal computed tomography showed extremely dilated bowel in the right lower abdomen that resembled a "coffee bean" in appearance. However, there was no evidence of air-distention in the descending colon. A colonoscopy did not show any bowel obstruction of the left side colon. We diagnosed a cecal volvulus associated with intestinal strangulation. An emergency laparotomy was thus performed. During the laparotomy, the ileocecal region, which was unfixed at the retroperitoneum, was found to be twisted clockwise 360°around the mesentery with the terminal ileum, thus resulting in a diagnosis of cecal volvulus. Since the colonic wall demonstrated vascular compromise and patchy gangrene, we therefore conducted an ileocecal resection without detorsion and reperfusion, followed by primary anastomosis. The patient recovered with minor complication. This case demonstrates the need for clinicians to consider cecal volvulus as a possible cause of acute abdomen. Abdominal computed tomography studies in such patients may enable early diagnosis. Resection without detorsion and reperfusion is the favored option for gangrenous bowel.
長崎大学の論文

Cecal Volvulus: Report of a Case

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