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Coco D, Leanza S. Large Bowel Occlusion: Clinical and Imaging Characteristics - Caecum Volvulus. Open Access Maced J Med Sci 2019; 7:2150-2153. [PMID: 31456843 PMCID: PMC6698115 DOI: 10.3889/oamjms.2019.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND: Caecum volvulus (CV) is defined as an axial twisting that causes an inversion position of the caecum, ascending colon and terminal ileum. This anatomical finding is responsible for some clinical features. Obstruction and strangulation are the most important and life-threatening. CASE PRESENTATION: We are presenting a 50 years old woman presented to the hospital with sudden acute severe abdominal pain and distension of about 24 hours associated with vomiting and no flatus. CONCLUSION: Mortality in patients with CV can be kept near 10%-12% if operative intervention is accomplished before caecum strangulation. Once the cecum has become gangrenous, a death rate of 30 to 40% can be expected. Tailored made surgery on patients status is the strategy.
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Affiliation(s)
- Danilo Coco
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Silvana Leanza
- Division of General Surgery, Carlo Urbani Hospital, Jesi, Italy
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Mazine K, Elbouhaddouti H, Toughrai I, Mouaqit O, Benjelloun E, Ousadden A, Taleb KA. [Volvulus of the cecum: a rare cause of intestinal occlusion: about two cases]. Pan Afr Med J 2018. [PMID: 29541308 PMCID: PMC5847055 DOI: 10.11604/pamj.2017.28.162.12237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Le Cæcum est, en fréquence, la deuxième partie du colon concernée par le volvulus après le sigmoïde et avant l'angle gauche et le côlon transverse. Cette affection survient sur des cæcums anormalement mobiles. Le mécanisme du volvulus est la torsion ou la bascule. Le tableau clinique est celui d'une occlusion intestinale aiguë par strangulation. L'abdomen sans préparation (ASP) et la TDM abdominale sont les examens radiologique de premier choix pour le diagnostic. Le traitement consiste en une chirurgie en urgence avec résection du cæcum et de l'iléon terminal. Nous rapportons deux cas de volvulus du cæcum admis aux urgences dans un tableau d'occlusion intestinale aiguë, le diagnostic était confirmé chez les deux patients par un scanner abdomino-pelvien et le traitement consistait en une résection iléo-colique avec rétablissement immédiate de continuité, les suites post opératoires étaient simples.
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Affiliation(s)
- Khalid Mazine
- Service de Chirurgie Viscérale A(C3), CHU Hassan II, Fès, Maroc
| | | | - Imane Toughrai
- Service de Chirurgie Viscérale B(E3), CHU Hassan II, Fès, Maroc
| | - Ouadie Mouaqit
- Service de Chirurgie Viscérale A(C3), CHU Hassan II, Fès, Maroc
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Solass W, Struller F, Horvath P, Königsrainer A, Sipos B, Weinreich FJ. Morphology of the peritoneal cavity and pathophysiological consequences. Pleura Peritoneum 2017; 1:193-201. [PMID: 30911623 DOI: 10.1515/pp-2016-0023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 11/29/2016] [Indexed: 01/05/2023] Open
Abstract
The peritoneal cavity (cavum peritonei) is incompletely divided into spaces and recessus (or fossae), which are playing an important role in health and disease. Peritoneal subspaces are determined by the parietal attachments of the abdominal organs, the ligaments and mesenteries. These include the splenorenal, the falciform, the triangular, the gastrosplenic, the phrenicocolic and the gastrocolic ligaments; the greater omentum and the lesser omentum (formed by the gastrohepatic and hepatoduodenal ligaments); the small bowel mesenterium and the mesocolon. These ligaments and mesenteries divide the peritoneal cavity into several distinct anatomic and functional regions. The supramesocolic compartment is divided into a bilateral subphrenic space and a subhepatic space continuing into the lesser sac (bursa omentalis). The inframesolic compartment is divided into a left and right region by the mesentery. The right paracolic gutter communicates with the pelvis and with the right suphrenic space. The left paracolic gutter is separated from the left subphrenic space by the phrenocolic ligament. The peritoneal space is virtual, is completely occupied by the intraabdominal organs and can only be visualized by radiological means in the presence of air (organ perforation), liquid (ascites, pus, bile, gastrointestinal fluids) or tumor invasion. Peritoneal morphology has numerous pathophysiological implications: it impacts on the propagation of intraabdominal infections, determines the spreading of peritoneal metastasis and can cause bowel volvulus. Internal hernias can arise at the junction between intraperitoneal and extraperitoneal bowel segments, in particular into the left paraduodenal recessus. Knowledge of peritoneal morphology is a precondition for developing locoregional therapeutic strategies in peritoneal disease and for effective peritoneal dialysis.
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Affiliation(s)
- Wiebke Solass
- Institute of Pathology, University of Tübingen, Tübingen, Germany
| | - Florian Struller
- Department of General and Transplant Surgery, Experimental Surgery, University of Tübingen, Tübingen, Germany
| | - Philipp Horvath
- Department of General and Transplant Surgery, Experimental Surgery, University of Tübingen, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General and Transplant Surgery, Experimental Surgery, University of Tübingen, Tübingen, Germany
| | - Bence Sipos
- Institute of Pathology, University of Tübingen, Tübingen, Germany
| | - Frank-Jürgen Weinreich
- Department of General and Transplant Surgery, Experimental Surgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany
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Keskin S, Keskin Z, Gunduz M, Sekmenli T, Kivrak HY. Gangrenous Appendicitis in a Boy with Mobile Caecum. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e11076. [PMID: 26060548 PMCID: PMC4457967 DOI: 10.5812/iranjradiol.11076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/01/2013] [Accepted: 05/28/2013] [Indexed: 12/13/2022]
Abstract
A mobile caecum and ascending colon is an uncommon congenital disorder, and it is even rarer as the cause of an acute abdomen during childhood. This report presents the case of a 6-year-old boy with acute gangrenous appendicitis with a mobile caecum and ascending colon. Data from the surgical course, as well as laboratory and imaging studies, were acquired and carefully examined. Emergency ultrasound (US) was performed and revealed no signs of appendicitis in the right lower quadrant. Serial imaging study, including non-enhanced computed tomography (CT), was performed. An imaging study identified epigastric appendicitis with mobile caecum. Surgery was executed under general anesthesia with a median incision extending from the epigastrium to the suprapubic region. The caecum was mobile and placed in the right epigastric area, next to the left lobe of the liver and gallbladder. The gangrenous appendix was discovered posterior to the caecum and transverse colon, enlarging to the left upper quadrant. Appendectomy was executed, the gangrenous appendix was confirmed pathologically, and the patient was released 4 days later. In the US, if there are unusual clinical findings or no findings in patients with abdominal pain, CT is beneficial in determining the location of the caecum and appendix and preventing misdiagnosis in children.
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Affiliation(s)
- Suat Keskin
- Department of Radiology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
- Corresponding author: Suat Keskin, Meram School of Medicine, Necmettin Erbakan University, Beysehir Street, Akyokus, Meram, Konya, Turkey. Tel: +90-5324887002, Fax: +90-3322236181, E-mail:
| | - Zeynep Keskin
- Department of Radiology, Konya Training and Research Hospital, Konya, Turkey
| | - Metin Gunduz
- Department of Pediatric Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Taner Sekmenli
- Department of Pediatric Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Hatice Yazar Kivrak
- Department of Radiology, Konya Training and Research Hospital, Konya, Turkey
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Diagnosis of Appendicitis in Patients with Abnormal Position of the Appendix due to Mobile Caecum. Case Rep Surg 2012; 2012:921382. [PMID: 23227414 PMCID: PMC3512262 DOI: 10.1155/2012/921382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/23/2012] [Indexed: 11/17/2022] Open
Abstract
Acute appendicitis is usually diagnosed on the basis of signs, symptoms, clinical history, physical examination, and results of laboratory tests.The position of the appendix can vary considerably, both in relation to the caecum and because of the inconsistent position of the caecum itself, and may cause variable clinical symptoms. We present the CT findings of surgically proven acute appendicitis associated with atypically located caecum in two patients.
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Abstract
To hypothesize that mobile cecum is a rare etiological factor and cecopexy is the choice of treatment in patients with recurrent right lower abdominal pain. Prospective study was conducted in the department of general surgery, SSG Hospital, Baroda, from January 2008 to December 2009. Patients with recurrent right lower abdominal pain were planned for appendectomy. In those patients with intraoperative findings suggestive of macroscopically normal appendix while cecum found to be mobile and no other gross abnormality, appendectomy was performed with cecopexy, fixing cecum to lateral abdominal wall with polypropylene 3-0 suture in interrupted manner. Histopathological examination was confirmed in all the cases. A total of 110 patients complaining of recurrent right lower abdominal pain, with clinical and radiological findings suggestive of appendicitis, were planned for appendectomy. Of 110 patients, 20 were found to have macroscopically normal appearing appendix and of those 20 patients, 8 had cecum unattached to the lateral peritoneal wall. The rest of 90 patients had grossly inflamed appendix in which 10 patients had cecum unattached to the lateral peritoneal wall. Appendectomy and cecopexy were performed in all the patients. On histological examination of the excised appendices, of those 20 with macroscopically normal appearance, 11 had features suggestive of chronic appendicitis and remaining 9 patients were found to have normal histology. While the other 90 with grossly inflamed appendix showed pathological changes of acute inflammation. A total of 64 patients of 110 were followed up till date with no recurrence of abdominal pain. A mobile cecum should be considered a cause of recurrent right lower abdominal pain, and cecopexy is easy to perform and good treatment of choice for a mobile cecum.
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Martin MJ, Steele SR. Twists and turns: a practical approach to volvulus and intussusception. Scand J Surg 2010; 99:93-102. [PMID: 20679045 DOI: 10.1177/145749691009900210] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M J Martin
- Trauma and Emergency Surgery Service, Legacy Emanuel Hospital, Portland, OR, USA.
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Pernin M, Legname M, Naulet P, Bertinotti C, Delpy R, Rey P. [Cecal volvulus: an exceptional complication of colonoscopy]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2009; 33:1013-1016. [PMID: 19246167 DOI: 10.1016/j.gcb.2009.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 01/15/2009] [Accepted: 01/16/2009] [Indexed: 05/27/2023]
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Ruiz-Tovar J, Calero García P, Morales Castiñeiras V, Martínez Molina E. [Caecal volvulus: presentation of 18 cases and review of literature]. Cir Esp 2009; 85:110-3. [PMID: 19231467 DOI: 10.1016/j.ciresp.2008.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 09/05/2008] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Caecal volvulus is the second most frequent location of colonic volvulus after sigmoid colon. It usually shows up as bowel obstruction. MATERIAL Y METHOD: We review our experience of 18 cases of cecal volvulus treated in our centre between 1987 and 2007. RESULTS We studied 8 males (44.4%) and 10 females (55.6%), with a mean age of 63.3 years. As an associated factor it was noted that 10 patients (55.6%) were bedridden. The most common clinical signs were abdominal distension and tenderness, constipation and vomiting. Simple abdominal X-rays have a low diagnostic accuracy, though they reveal a bowel obstruction. Only 1 patient underwent elective surgery. In 10 patients (55.6%) a right hemicolectomy was performed, in 3 (16.8%) cecostomy, in 3 cecopexy and in 2 (11.2%) devolvulation only. There were complications in 3 patients (16.8%), 2 prolonged ileus and 1 wound infection. There were no recurrences. CONCLUSIONS Caecal volvulus is an emergency pathology, requiring surgical treatment. Right hemicolectomy is the treatment of choice both in viable and gangrenous colon. Caecostomy is an alternative treatment in the high risk patient with a viable colon.
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Affiliation(s)
- Jaime Ruiz-Tovar
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España.
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