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Gowthaman D, Scanlon L, McAuliffe JC, Fidvi S, Schwartz C, Isani SS. Cecal volvulus after robotic assisted laparoscopic hysterectomy in a gynecologic oncology patient: A case report. Gynecol Oncol Rep 2024; 53:101404. [PMID: 38765696 PMCID: PMC11101701 DOI: 10.1016/j.gore.2024.101404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024] Open
Abstract
Cecal volvulus is a rare and life-threatening cause of intestinal obstruction with multiple risk factors including prior abdominal surgery and cecal hypermobility. Although its incidence has been reported after common procedures such as cholecystectomy and appendectomy, it has not been well studied after laparoscopy, especially in gynecological surgeries. If untreated, a cecal volvulus can result in serious complications such as intestinal strangulation, necrosis, or perforation. Therefore, early identification of risk factors and intervention is important in prevention of these sequelae. Here, we report a case of cecal volvulus in a patient with endometrial carcinoma after a staging robotic-assisted laparoscopic hysterectomy and the risk factors that may have led to her complication.
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Affiliation(s)
- Divya Gowthaman
- Department of Obstetrics and Gynecology and Women's Health, Division of Gynecologic Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, USA
| | - Lauren Scanlon
- Department of Obstetrics and Gynecology and Women's Health, Division of Gynecologic Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, USA
| | - John C. McAuliffe
- Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, USA
| | - Shabnam Fidvi
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, USA
| | - Carly Schwartz
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, USA
| | - Sara S. Isani
- Department of Obstetrics and Gynecology and Women's Health, Division of Gynecologic Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, USA
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2
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Brown J, Dick L, Watson A. Volvulus of the gastrointestinal tract. Br J Hosp Med (Lond) 2024; 85:1-9. [PMID: 38557088 DOI: 10.12968/hmed.2023.0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Volvulus describes the twisting of the intestine or colon around its mesentery. Intestinal obstruction and/or ischaemia are the most common complications of volvulus. Within the gastrointestinal tract, there is a preponderance towards colonic volvulus. The sigmoid is the most commonly affected segment, followed by the caecum, small intestine and stomach. Distinguishing between the differing anatomical locations of gastrointestinal volvulus can be challenging, but is important for the management and prognosis. This article focuses on the main anatomical sites of gastrointestinal volvulus encountered in clinical practice. The aetiology, presentation, radiological features and management options for each are discussed to highlight the key differences.
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Affiliation(s)
- Jasmine Brown
- Department of Plastic Surgery, NHS Education for Scotland, Edinburgh, Scotland, UK
| | - Lachlan Dick
- Department of Medical Education, NHS Lothian, Edinburgh, Scotland, UK
| | - Angus Watson
- Department of General Surgery, NHS Highland, Inverness, Scotland, UK
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3
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Soliman M, Magnetta M, Salinas A, Feinn RS, Velichko YS, Miller FH, Kelahan LC. Evaluation of 18 CT signs in diagnosing cecal volvulus: a multi-reader retrospective study. Abdom Radiol (NY) 2024; 49:357-364. [PMID: 37989898 DOI: 10.1007/s00261-023-04092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To assess the diagnostic performance and reliability of 18 CT signs to diagnose cecal volvulus, a surgical emergency, versus a group of non-volvulus mimickers. MATERIALS AND METHODS Four radiologists retrospectively and independently assessed 18 CT signs in 191 patients with cecal volvulus (n = 63) or a non-volvulus control group ((n = 128), including cecal bascule (n = 19), mobile cecum (n = 95), and colonic pseudo-obstruction (n = 14)) at a single institution from 2013 to 2021. Fleiss' kappa coefficient was used to assess inter-reader agreement. For diagnostic performance metrics, we assessed sensitivity, specificity, and positive and negative predictive values. For predictive performance, all 18 signs were included in bivariate and stepwise lasso multivariate logistic regression models to diagnose cecal volvulus. Performance was assessed by ROC curves. RESULTS 191 patients (mean age: 63 years +/- 15.5 [SD]; 135 women) were included in the study. Nine of the 18 CT signs of cecal volvulus demonstrated good or better (> 0.6) inter-reader agreement. Individual CT signs with sensitivity, specificity, positive and negative predictive values all above 70% for diagnosing cecal volvulus were transition point, bird beak, and X-marks-the-spot. A lasso regression model determined four CT features: transition point, bird beak, coffee bean, and whirl had excellent prediction (AUC = .979) for cecal volvulus if all present. CONCLUSION CT signs for cecal volvulus that have high sensitivity and specificity include: transition point, bird beak, and X-marks-the-spot and were reliable in distinguishing non-volvulus mimickers. If the following four features were present: transition point, bird beak, coffee bean, and whirl, there was excellent prediction (AUC = .979) for cecal volvulus.
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Affiliation(s)
- Moataz Soliman
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Michael Magnetta
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Abraham Salinas
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | | | - Yuri S Velichko
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Linda C Kelahan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 800, Chicago, IL, 60611, USA.
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4
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Ijezie N, Abolaji S. Atypical Presentation of Cecal Volvulus. Cureus 2023; 15:e47343. [PMID: 38021984 PMCID: PMC10657237 DOI: 10.7759/cureus.47343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Cecal volvulus, despite being the second most common type of intestinal volvulus after sigmoid volvulus, frequently gets underdiagnosed in clinical practice. Further, management of this intestinal pathology, which requires a considerable amount of expertise, could be lacking due to the similarities in presentation with other intestinal obstructive pathologies, or the infrequency associated with the performance of required diagnostic and therapeutic procedures. We describe a case of a 47-year-old female who presented with acute cecal volvulus. In this case, prompt surgical intervention ensured the best possible outcome with preservation of the cecum via a less sophisticated surgical approach. It therefore becomes apparent that there exists other surgical options in the optimal management of cecal volvulus that ensure no part of the bowel is lost, although this is time-bound.
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Affiliation(s)
- Nzubechukwu Ijezie
- Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, GBR
- Surgery, Epsom and St Helier University Hospitals NHS Trust, Sutton, GBR
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5
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Jeo WS, Prawirodihardjo MMP, Putranto AS, Mazni Y. Caecopexy as management for caecal volvulus: An evidence-based case report. Int J Surg Case Rep 2023; 111:108862. [PMID: 37776685 PMCID: PMC10556757 DOI: 10.1016/j.ijscr.2023.108862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The incidence of caecal volvulus (CV) reaches 2.8-7.1 per million per year. CV is a surgical emergency that must be treated immediately because the mortality rate can reach 30 %, and the recurrence rate is 40 %. This study showed a case illustration of caecal volvulus with evidence-based recommendations for indications and management of caecopexy based on postoperative outcomes. CASE PRESENTATION 33-Year-old male came with chief complaints of persistent acute abdominal pain one day before hospital admission. Pain is felt suddenly throughout the abdomen. On physical examination, palpable pain in the entire abdomen is obtained, accompanied by the muscular defence with increased bowel sounds. The laboratory only showed increased white blood cells. Abdominal computed tomography (CT) with contrast showed closed-loop obstruction (CLO) signs. CLINICAL DISCUSSION Caecopexy technique use is supported in a case series because it can be done safely, quickly, and without the need to open intestinal segments. Based on previous researches, there were none to low rate of morbidity, mortality, and recurrence. In this patient, caecopexy was carried out and showed good output with no complications. CONCLUSION Caecopexy is a safe, simple, and less invasive procedure. The advantages of the caecopexy technique are low morbidity, mortality, and recurrence. The patient's outcome in this illustration is consistent with other literature. Thus it can be used as evidence-based recommendations in the management of the next case of caecal volvulus.
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Affiliation(s)
- Wifanto Saditya Jeo
- Division of Digestive Surgery, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
| | | | - Agi Satria Putranto
- Division of Digestive Surgery, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Yarman Mazni
- Division of Digestive Surgery, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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6
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Sapkota A, Batajoo A, Lamichhane S, Shrestha A, Bhatt N. Twists and turns: A case report of cecal volvulus. Clin Case Rep 2023; 11:e7936. [PMID: 37736477 PMCID: PMC10509340 DOI: 10.1002/ccr3.7936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
We present a case of a 22-year-old male presenting in the emergency room with colicky abdominal pain, vomiting, and abdominal distension for which an early computed tomography scan was done and diagnosed as cecal volvulus. Following diagnosis case was managed promptly by laparotomy with right hemicolectomy and primary anastomosis.
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7
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Al Khalifa A, Sedik A. Cecal Volvulus: A Report of a Challenging Case. Cureus 2023; 15:e45753. [PMID: 37872938 PMCID: PMC10590477 DOI: 10.7759/cureus.45753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
Cecal volvulus represents a rare form of acute intestinal obstruction caused by an axial twist of the terminal ileum, ascending colon, and cecum surrounding the mesenteric pedicle. It is responsible for 1%-1.5% of all intestinal obstruction cases in adults. Radiological imaging assists in the diagnosis of cecal volvulus, particularly a CT scan with contrast as the gold standard for both diagnosis and risk assessment. In this case report, we present a challenging case of cecal volvulus seen in a 75‑year‑old male patient with multiple comorbidities who presented with abdominal guarding/tenderness and high WBC and lactate, which evolved into septic shock. The purpose of this study is to underline the significance of early diagnosis and effective treatment of this uncommon condition in abdominal surgeries.
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Affiliation(s)
- Ahmed Al Khalifa
- College of Medicine, Sulaiman Alrajhi University, Al Bukayriyah, SAU
| | - Alaa Sedik
- General Surgery, King Khalid General Hospital, Hail, SAU
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8
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M S V, S VS, Viswanathan VM, Palit SR, Kevin C. Caecal Volvulus Presenting as an Obstructed Inguinal Hernia: A Case Report. Cureus 2023; 15:e45963. [PMID: 37900401 PMCID: PMC10600403 DOI: 10.7759/cureus.45963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/31/2023] Open
Abstract
Caecal volvulus (CV) is an uncommon cause of large intestinal obstruction due to the axial torsion of the caecum, ascending colon, and terminal ileum. We describe the case of a 37-year-old man who presented with bilateral inguinal hernias (the left larger than the right), diffuse abdominal pain, vomiting, difficulty passing stool, and flatus that were comparable to those of an obstructed hernia. Imaging tests revealed a collapsed ascending colon, free fluid collection, and a significantly dilated proximal ileum. An urgent laparotomy showed a perforated, clockwise-twisted caecum that required a right hemicolectomy. Postoperatively, the patient had a good recovery. CV is uncommon, and its symptoms are vague, making diagnosis difficult. For an accurate diagnosis and prompt action, imaging tools and a high index of suspicion are essential. This case serves as a reminder of the significance of taking rare entities into consideration in developing a differential diagnosis of complex abdominal presentations and the necessity for a differential diagnostic approach to choose the most suitable surgical course of action.
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Affiliation(s)
- Viswanathan M S
- General and Plastic surgery, Employees' State Insurance Corporation (ESIC) Medical College & Hospital, Chennai, IND
| | - Vidhya Sree S
- General Surgery, Employees' State Insurance Corporation (ESIC) Medical College & Hospital, Chennai, IND
| | - Varun M Viswanathan
- General Surgery, Employees' State Insurance Corporation (ESIC) Medical College & Hospital, Chennai, IND
| | - Sandhya R Palit
- General and Colorectal Surgery, Employees' State Insurance Corporation (ESIC) Medical College & Hospital, Chennai, IND
| | - Chris Kevin
- General Surgery, Employees' State Insurance Corporation (ESIC) Medical College & Hospital, Chennai, IND
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9
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Gislinge JIP, Scheuer CJ, Toustrup CH, Roenneberg ET. Caecal volvulus following a complicated caesarean section. BMJ Case Rep 2023; 16:e252757. [PMID: 37607760 PMCID: PMC10445342 DOI: 10.1136/bcr-2022-252757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
A caecal volvulus is a rare, but severe complication to a caesarean section, with serious risks of perforation, necrosis and peritonitis. We describe a case of a Middle Eastern woman admitted for an elective caesarean section due to a history of three cesareans in her home country. The operation was complicated by massive adhesions and a postpartum bleed of 1750 mL. She developed severe abdominal pain refractory to strong pain medication postoperatively. She was diagnosed with a caecal volvulus without perforation on CT, which was confirmed by laparotomy. The patient was treated with a hemicolectomy and made a full recovery.
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Affiliation(s)
| | | | | | - Elisabeth Thal Roenneberg
- Gynecology, Obstetrics and Fertility, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark
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10
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Tian BWCA, Vigutto G, Tan E, van Goor H, Bendinelli C, Abu-Zidan F, Ivatury R, Sakakushev B, Di Carlo I, Sganga G, Maier RV, Coimbra R, Leppäniemi A, Litvin A, Damaskos D, Broek RT, Biffl W, Di Saverio S, De Simone B, Ceresoli M, Picetti E, Galante J, Tebala GD, Beka SG, Bonavina L, Cui Y, Khan J, Cicuttin E, Amico F, Kenji I, Hecker A, Ansaloni L, Sartelli M, Moore EE, Kluger Y, Testini M, Weber D, Agnoletti V, Angelis ND, Coccolini F, Sall I, Catena F. WSES consensus guidelines on sigmoid volvulus management. World J Emerg Surg 2023; 18:34. [PMID: 37189134 DOI: 10.1186/s13017-023-00502-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
Sigmoid volvulus is a common surgical emergency, especially in elderly patients. Patients can present with a wide range of clinical states: from asymptomatic, to frank peritonitis secondary to colonic perforation. These patients generally need urgent treatment, be it endoscopic decompression of the colon or an upfront colectomy. The World Society of Emergency Surgery united a worldwide group of international experts to review the current evidence and propose a consensus guidelines on the management of sigmoid volvulus.
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Affiliation(s)
- Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Gabriele Vigutto
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cino Bendinelli
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Rao Ivatury
- Professor Emeritus Virginia Commonwealth University, Richmond, VA, USA
| | - Boris Sakakushev
- Research Institute at Medical University Plovdiv, University Hospital St George, Plovdiv, Bulgaria
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Ronald V Maier
- Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Raul Coimbra
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UCSD Health System - Hillcrest Campus, San Diego, CA, USA
| | - Ari Leppäniemi
- Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Andrey Litvin
- Department of Surgery, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Dimitrios Damaskos
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Richard Ten Broek
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Walter Biffl
- Queen's Medical Center, University of Hawaii, Honolulu, HI, USA
| | - Salomone Di Saverio
- Trauma and General Surgeon Royal Perth Hospital, The University of Western Australia, Perth, Australia
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Marco Ceresoli
- Emergency and General Surgery Department, University of Milan-Bicocca, Milan, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Joseph Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | - Giovanni D Tebala
- Department of Digestive and Emergency Surgery, S. Maria Hospital Trust, Terni, Italy
| | - Solomon Gurmu Beka
- School of Medicine and Health Science, University of Otago, Wellington Campus, Wellington, New Zealand
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Yunfeng Cui
- Department of Surgery, Nankai Clinical School of Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, University of Portsmouth, Southwick Hill Road, Cosham, Portsmouth, UK
| | - Enrico Cicuttin
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Francesco Amico
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Inaba Kenji
- Division of Trauma, Critical Care University of Southern California, Los Angeles, USA
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Luca Ansaloni
- General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Ernest E Moore
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Mario Testini
- Academic Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Nicola De' Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris, France
| | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal.
| | - Fausto Catena
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
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11
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Abbassi I, Triki W, Trigui R, Ben Salah R, Itaimi A, Ayed K, Sebri H, Baraket O, Bouchoucha S. Case Report: Caecal volvulus management from diagnosis to treatment in a young patient. F1000Res 2022; 11:781. [PMID: 35999844 PMCID: PMC9360906 DOI: 10.12688/f1000research.121789.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Caecal volvulus (CV) is a rare cause of intestinal obstruction, defined by an axial torsion of the caecum, ascending colon, and terminal ileum around the mesenteric vascular pedicles, leading to ischemia and bowel necrosis. A 20-year-old woman, with no significant medical history, was admitted for generalized abdominal pain evolving for three days, along with constipation and abdominal distension, but with no vomiting. Physical examination showed a generalized abdominal tenderness with no rigidity or rebound tenderness, associated with abdominal distension and tympanic upon percussion. Laboratory findings were within normal limits. An abdominal computed tomography scan revealed distension of a loop of the large bowel with its long axis extending from the right lower quadrant to the epigastrium or left upper quadrant. Colonic haustral pattern was absent. An abdominal computed tomography scan showed a rounded focal collection of air-distended bowel with haustral creases in the upper left quadrant. In addition, spiraled loops of the collapsed cecum (giving a whirl sign) were noted, along with low-attenuating fatty mesentery from the twisted bowel. The patient underwent an emergency laparotomy and caecectomy using GEA 80 charges. The patient had no complaints post-operation. CV is a rare cause of bowel obstruction, mainly caused by an exceedingly mobile caecum. Despite its rareness, CV represents the second most common cause of large bowel volvulus, behind sigmoid volvulus. For acute obstruction by CV, it is hard to differentiate it clinically from obstruction of the small bowel; therefore, radiological exams are needed. Surgery is the gold standard treatment for CV. We report a rare case of CV to highlight the rarity of this pathology, specify its diagnostic and therapeutic means, and its clinical and biological evolution.
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Affiliation(s)
- Imed Abbassi
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia,
| | - Wissem Triki
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Racem Trigui
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Ramy Ben Salah
- Plastic and Reconstructive Department, Hospital Habib Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Ahmed Itaimi
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Karim Ayed
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Hajer Sebri
- Gynecology and Obstetric Department, Hospital Mongi Slim of La Marsa, Tunis, 1000, Tunisia
| | - Oussema Baraket
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Sami Bouchoucha
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
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12
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Muacevic A, Adler JR. Caecal Volvulus, Untwisting the Twisted: A Case Report and Literature Review. Cureus 2022; 14:e30961. [PMID: 36465206 PMCID: PMC9711929 DOI: 10.7759/cureus.30961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 01/25/2023] Open
Abstract
Caecal volvulus is an uncommon surgical condition affecting mostly females in their second and third decade of life. It is of vital importance that the general surgeon recognises, resuscitates, diagnoses, and effectively treats these cases in a timely manner to maximise the chance of a positive outcome for the patient. Whilst there are several types of caecal volvulus, the treatment involves, in most cases, surgical intervention. There is a wide variety of surgical interventions that can be performed, ranging from caecopexy or fixation to lateral wall to performing a right hemicolectomy with primary ileocolic anastomosis. There are several factors that influence this decision and can also be based on an individual surgeon's expertise and experience. We present a case of a 21-year-old female who presented to our Emergency Department with lower abdominal pain, nausea, and vomiting. She was diagnosed with caecal volvulus with the aid of CT imaging, following which she underwent laparotomy in which caecal volvulus was noted. She underwent appendicectomy and caecopexy and was discharged after an uneventful recovery on post-operative day five and remains well on follow-up.
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13
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Abbassi I, Triki W, Trigui R, Ben Salah R, Itaimi A, Ayed K, Sebri H, Baraket O, Bouchoucha S. Case Report: Caecal volvulus management from diagnosis to treatment in a young patient. F1000Res 2022; 11:781. [PMID: 35999844 PMCID: PMC9360906 DOI: 10.12688/f1000research.121789.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 09/23/2023] Open
Abstract
Caecal volvulus (CV) is a rare cause of intestinal obstruction, defined by an axial torsion of the caecum, ascending colon, and terminal ileum around the mesenteric vascular pedicles, leading to ischemia and bowel necrosis. A 20-year-old woman, with no significant medical history, was admitted for generalized abdominal pain evolving for three days, along with constipation and abdominal distension, but with no vomiting. Physical examination showed a generalized abdominal tenderness with no rigidity or rebound tenderness, associated with abdominal distension and tympanic upon percussion. Laboratory findings were within normal limits. An abdominal computed tomography scan revealed distension of a loop of the large bowel with its long axis extending from the right lower quadrant to the epigastrium or left upper quadrant. Colonic haustral pattern was absent. An abdominal computed tomography scan showed a rounded focal collection of air-distended bowel with haustral creases in the upper left quadrant. In addition, spiraled loops of the collapsed cecum (giving a whirl sign) were noted, along with low-attenuating fatty mesentery from the twisted bowel. The patient underwent an emergency laparotomy and caecectomy using GEA 80 charges. The patient had no complaints post-operation. CV is a rare cause of bowel obstruction, mainly caused by an exceedingly mobile caecum. Despite its rareness, CV represents the second most common cause of large bowel volvulus, behind sigmoid volvulus. For acute obstruction by CV, it is hard to differentiate it clinically from obstruction of the small bowel; therefore, radiological exams are needed. Surgery is the gold standard treatment for CV. We report a rare case of CV to highlight the rarity of this pathology, specify its diagnostic and therapeutic means, and its clinical and biological evolution.
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Affiliation(s)
- Imed Abbassi
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Wissem Triki
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Racem Trigui
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Ramy Ben Salah
- Plastic and Reconstructive Department, Hospital Habib Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Ahmed Itaimi
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Karim Ayed
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Hajer Sebri
- Gynecology and Obstetric Department, Hospital Mongi Slim of La Marsa, Tunis, 1000, Tunisia
| | - Oussema Baraket
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
| | - Sami Bouchoucha
- General Surgery Department, Hôpital Universitaire Bougatfa of Bizerte, Bizerte, 7000, Tunisia
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14
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Cecal Volvulus in a Teenaged Patient. J Pediatr 2022; 245:238. [PMID: 35301020 DOI: 10.1016/j.jpeds.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/20/2022]
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15
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Caecal Volvulus: A District General Hospital Experience and Review of the Literature. SURGERIES 2022. [DOI: 10.3390/surgeries3020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Caecal volvulus (CV) is an uncommon cause of large bowel obstruction with potential for complications such as ischaemia and perforation. Prompt diagnosis and treatment only will ensure better outcomes. We aim to describe our experience in the largest series of CV reported in the United Kingdom. Methods: This was a retrospective study of 16 consecutive patients diagnosed with CV between March 2017 and March 2020. Results: Out of 16 patients, 11 were female, with a median age of 64 (range 33–80) years. All patients presented with abdominal pain and vomiting. An initial diagnosis of bowel obstruction was made only in 8 patients (50%). Computed tomography (CT) scan of the abdomen and pelvis correctly diagnosed CV in fourteen (87.5%). Fifteen patients (94%) underwent surgical intervention. All but one (n = 14, 93.4%) underwent laparotomy, and one patient (6.6%) underwent successful laparoscopic intervention. Right hemicolectomy was performed in all operated patients, and fourteen patients (93.4%) had primary anastomosis. Twelve patients (80%) had one or another form of morbidity. Seven patients (47%) and three patients (20%) had grade II and III (Clavien–Dindo Classification) complications, respectively, with a median hospital stay of 10 (range 1–49) days. One patient (6.7%) managed conservatively was deemed to be futile. There was no postoperative mortality. Conclusions: CV can present with non-specific symptoms, and a definite preoperative diagnosis is only possible with the aid of CT. Open resectional procedures with primary anastomosis are the most favoured approach in management, though laparoscopic access is also feasible in fit patients.
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Tuler S, Kaur J, Dasanu CA. Cecal volvulus associated with carfilzomib use for al amyloidosis. J Oncol Pharm Pract 2022:10781552221074719. [PMID: 35089100 DOI: 10.1177/10781552221074719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Proteasome inhibitors have emerged as quintessential therapies for light-chain (AL) amyloidosis and multiple myeloma in the last decade. While these agents are highly effective, reports have also documented toxicities affecting various organ systems. Whereas gastrointestinal (GI) toxicities are a relatively common occurrence with proteasome inhibitors, severe GI complications are exceedingly rare. CASE REPORT We describe a unique case of a patient with AL amyloidosis who developed cecal volvulus after four weeks of treatment with carfilzomib. This severe GI manifestation has not been previously described in the literature. MANAGEMENT AND OUTCOME The patient required right hemicolectomy. After clinical recovery, she restarted reduced-dose carfilzomib. She did not have any severe GI side effects following dose reduction, and continues with the current treatment regimen to the present day. DISCUSSION/CONCLUSION The causality between volvulus and the treatment with carfilzomib was probable, with a documented score of 6 on the Naranjo probability nomogram. The exact mechanism behind this effect of carfilzomib has yet to be elucidated.
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Affiliation(s)
- Shahaf Tuler
- Department of Medicine, 541618Eisenhower Health, Rancho Mirage, CA, USA
| | - Jaspreet Kaur
- Department of Medicine, 541618Eisenhower Health, Rancho Mirage, CA, USA
| | - Constantin A Dasanu
- Lucy Curci Cancer Center, 541618Eisenhower Health, Rancho Mirage, CA, USA.,UC San Diego Health, San Diego, CA, USA
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17
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Mahendran V, Reddy B, Jaradat I. The Unfolding Situation of Caecal Volvulus: A Retrospective Analysis of 36 Cases From a Single Center. Cureus 2022; 14:e21071. [PMID: 35028246 PMCID: PMC8744366 DOI: 10.7759/cureus.21071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Caecal volvulus (CV) is a rare cause of bowel obstruction. However, there has been a steady rise in the number of cases over the decades. The demographic profile of patients developing CV has changed to a much older population. We conducted a retrospective review to determine the incidence, demographic profile, management, and outcomes of CV patients in our institution during the last nine years. Methodology A retrospective audit of all patients diagnosed with CV at Worcestershire Acute Hospitals NHS Trust between 01 January 2011 and 31 March 2020 was performed. Patients admitted with any other type of volvuli such as sigmoid volvulus, small bowel volvulus, and gastric volvulus were excluded. A systematic search of the electronic medical records for all patients admitted under the International Classification of Diseases, Tenth Revision code K562: volvulus was performed for the study duration. It yielded a total of 1,019 patients. After excluding all patients who did not have either a CV or caecal bascule, we included 36 patients in the final analysis. Results Most of our patients were females (78%) with a median age was 76 years. The majority (86%) had at least one medical comorbidity, and 36% had a previous abdominal operation. Abdominal pain was the main complaint in 94% of patients. All patients had undergone a computed tomography (CT) scan to confirm their diagnosis. Most of our patients (84%) underwent surgery. Open right hemicolectomy was the most commonly performed operation (87%). Out of the six patients who did not undergo surgery, three responded to bowel rest and nasogastric tube decompression; one patient underwent successful colonoscopic decompression. In contrast, two patients, unfortunately, passed away. The median length of hospital stay was nine days, with a 30-day mortality of 3%. Conclusions CV remains a rare cause of bowel obstruction. Most of our patients were old, frail, and had medical comorbidities. More than one-third of patients had undergone previous abdominal surgery. Early CT scan followed by right hemicolectomy was associated with low mortality.
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18
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Sylvester KR, Ooko PB, Mwachiro MM, Parker RK. Cecal volvulus in rural Kenya: delayed presentation contributes to high mortality. BMC Surg 2021; 21:430. [PMID: 34923984 PMCID: PMC8684650 DOI: 10.1186/s12893-021-01416-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background Cecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. It is a rare reported cause of adult intestinal obstruction. This study aimed to review the clinical presentation, management, and outcomes at a rural, resource-limited referral center. Methods We performed a retrospective review of all patients with a diagnosis of cecal volvulus between January 1st, 2009 and December 31st, 2019 at Tenwek Hospital in Bomet, Kenya. The outcome of survival was compared by the time to presentation. Mortality was also compared with prior reports of intestinal obstruction at our institution. Results Thirteen patients were identified with a mean age of 52 years and a mean symptom duration of 5 days. All patients presented with abdominal pain and distension. Seven patients (54%) presented with perforation, gangrene, or gross peritoneal contamination. Identified risk factors were Ladds bands with malrotation, adhesions, and a sigmoid tumor. Procedures included primary resection and anastomosis (7), damage control (3) with anastomosis on second-look in 2 of these, simple surgical detorsion (1), and surgical detorsion and cecopexy (2). There were four mortalities (31%), of which all had delayed presentation with perforation and fecal contamination. Delays to presentation were associated with mortality (p = 0.03). Cecal volvulus resulted in increased perioperative mortality compared to all intestinal obstructions presenting to the institution (p < 0.0001). Conclusions Cecal volvulus carries a high risk of mortality. A high index of suspicion and early consideration in the differential diagnosis of intestinal obstruction should be considered to reduce the mortality associated with the delay in preoperative diagnosis.
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Affiliation(s)
| | - Philip B Ooko
- Department of Surgery, AIC Litein Hospital, Litein, Kenya
| | | | - Robert K Parker
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya. .,Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA.
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19
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Rout A, Pillai S. Caecal volvulus: high index of suspicion is the key to early diagnosis. J Surg Case Rep 2021; 2021:rjab517. [PMID: 34868549 PMCID: PMC8634507 DOI: 10.1093/jscr/rjab517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/01/2021] [Indexed: 11/12/2022] Open
Abstract
Caecal volvulus represents an uncommon acute surgical presentation of bowel obstruction. Familiarity with particular long-term symptoms and pre-disposing factors can help a clinician identify caecal volvulus as a possible diagnosis. There has been a changing vogue of radiological investigation and surgical interventions. We present a summary of these options.
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Affiliation(s)
- Alexandra Rout
- Department of General Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Sandhya Pillai
- Department of General Surgery, Middlemore Hospital, Auckland, New Zealand
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20
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Alavi K, Poylin V, Davids JS, Patel SV, Felder S, Valente MA, Paquette IM, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction. Dis Colon Rectum 2021; 64:1046-1057. [PMID: 34016826 DOI: 10.1097/dcr.0000000000002159] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Karim Alavi
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Jennifer S Davids
- University of Massachusetts Medical School, Worcester, Massachusetts
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21
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Sikakulya FK, Kiyaka SM, Masereka R, Onyai P, Okedi XF, Anyama P. Cecal volvulus in an adult male: A rare cause of intestinal obstruction: A case report. Int J Surg Case Rep 2021; 85:106186. [PMID: 34247122 PMCID: PMC8278423 DOI: 10.1016/j.ijscr.2021.106186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction and importance Cecal volvulus is uncommon cause of intestinal obstruction. It affects the ascending colon and the terminal part of the ileum which are twisted around the mesenteric pedicle. Case presentation We report the case of 37-year-old male who underwent emergency laparotomy for intestinal obstruction and found a twisted cecum with ileal knotting and anterior part of cecum necrosed. Resection of cecum and terminal ilium followed by end-to-end anastomosis of ileum to ascending colon were performed. Clinical discussion Cecal volvulus remains an uncommon cause of intestinal obstruction with a surgical incidence of 2.8–7.1 cases per year per 1 million people. Delay in diagnosis can lead to complications such as necrosis and perforation of the cecum. Conclusion We present a rare case of cecal volvulus in a 37-year-old male with necrosed part of the cecum without perforation. Early diagnosis and management can prevent perforation and reduce morbidity related to the cecal perforation. We report a 37years-old male with intestinal obstruction due to cecal volvulus without perforation The patient underwent resection of cecum and terminal ilium followed by end-to-end anastomosis A plain x-ray reported features of intestinal obstruction of no specific origin Early management of cecal volvulus can help in prevention of peritonitis secondary to cecal perforation
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Affiliation(s)
- Franck Katembo Sikakulya
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda; Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo.
| | - Sonye Magugu Kiyaka
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Robert Masereka
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda; Department of Surgery, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Patrick Onyai
- Department of Surgery, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Xaviour Francis Okedi
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Philip Anyama
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda; Department of Surgery, Jinja Regional Referral Hospital, Jinja, Uganda
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22
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Sudharshan M, Shaikh O, Panneerselvam R, Kumbhar U, Gaur NK. Caecal Volvulus Presenting as the Obstructed Right Inguinal Hernia. Cureus 2021; 13:e16264. [PMID: 34373819 PMCID: PMC8346269 DOI: 10.7759/cureus.16264] [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] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
Caecal volvulus is an uncommon cause of intestinal obstruction with varied clinical presentation. Surgical intervention without delay is considered the gold standard in its management. Strangulated inguinal hernia with caecal volvulus is a rarity. We report a case of a 55-year-old male with a history of long-standing right inguinal hernia, presented with the irreducibility of the hernia along with pain for one day. Clinically patient was diagnosed to have an obstructed inguinal hernia. On exploration, we found that there was a caecal volvulus in the hernia sac along with gangrene of the distal ileum, redundant sigmoid, and ascending colon. Resection and anastomosis of the gangrenous segment of the bowel were done along with herniorrhaphy and sigmoidopexy. Postoperatively patient improved without any complication.
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Affiliation(s)
- Mahalingam Sudharshan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Oseen Shaikh
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | | | - Uday Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Naveen Kumar Gaur
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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23
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Sluckin TC, Groen JJ, Smeets SJM, Schouten R. A Cecum Volvulus Herniating Through the Foramen of Winslow After Roux-en-Y Gastric Bypass: A Case Report. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Jasper J. Groen
- Department of Surgery, Flevoziekenhuis, Almere, The Netherlands
| | | | - Ruben Schouten
- Department of Surgery, Flevoziekenhuis, Almere, The Netherlands
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24
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A comprehensive radiologic review of abdominal and pelvic torsions. Abdom Radiol (NY) 2021; 46:2942-2960. [PMID: 33388807 DOI: 10.1007/s00261-020-02868-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
The clinical manifestations of abdominal and pelvic organ torsion can often be non-specific and can affect a wide range of ages and demographic groups. Radiologists have a key role in not only establishing the diagnosis of organ torsion, but also in the assessment of potential complications. As multiple imaging modalities may be utilized in the evaluation of abdominal and pelvic pain, recognizing the various appearances of organ torsion is important to ensure early diagnosis and thereby reducing patient morbidity and mortality, particularly since abdominal and pelvic organ torsion may not be clinically suspected at the time of initial patient presentation.
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25
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González Sánchez FJ, Pellón Daben R, Acebo García M, Sanchez Bernal S, Crespo Del Pozo J, González-Carreró Sixto C. Cecal bascule with secondary gastric outlet obstruction in addition to a large bowel closed obstruction: A case report. Radiol Case Rep 2021; 16:1469-1472. [PMID: 33936351 PMCID: PMC8079242 DOI: 10.1016/j.radcr.2021.02.038] [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: 11/08/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
We present a case of cecal bascule in a 60-year-old woman with abdominal pain and vomiting. Imaging tests revealed a cecal bascule causing mechanic obstruction of the stomach. Besides a small bowel dilatation was not seen, the distended cecum was extrinsically obstructing the antrum and therefore, the gastric outlet. Cecal bascule is a form of cecal volvulus without the axial twisted component. The cecum folds anterior or anteromedially on itself and, because of a valve mechanism, becomes distended. The pressure increases and it begins to compromise arterial blood flow so life-threatening complications, such as bowel ischemia and infarction can occur. Prompt diagnosis is therefore crucial and plain radiographs and computed tomography are the preferred imaging techniques for this purpose.
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Affiliation(s)
| | - Raúl Pellón Daben
- Radiology Department, Hospital Universitario Marqués de Valdecilla, Avda Valdecilla sn 39008, Santander, Spain
| | - Mercedes Acebo García
- Radiology Department, Hospital Universitario Marqués de Valdecilla, Avda Valdecilla sn 39008, Santander, Spain
| | - Sara Sanchez Bernal
- Radiology Department, Hospital Universitario Marqués de Valdecilla, Avda Valdecilla sn 39008, Santander, Spain
| | - Juan Crespo Del Pozo
- Radiology Department, Hospital Universitario Marqués de Valdecilla, Avda Valdecilla sn 39008, Santander, Spain
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26
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Morera-Grau A, Membrilla-Fernández E, González-Castillo AM, Pelegrina-Manzano A, Guerrero-Ortiz MA, Téllez-Marquès C, Pons-Fraguero MJ, Guzmán-Ahumada J, Pera-Román M, Sancho-Insenser JJ. Caecal volvulus and jejunostomy: challenging diagnostic. J Surg Case Rep 2021; 2021:rjab148. [PMID: 33927877 PMCID: PMC8068471 DOI: 10.1093/jscr/rjab148] [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: 03/10/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022] Open
Abstract
Caecal volvulus represent the 20–40% of colonic volvulus, being the second most frequent localization. It causes intestinal occlusion symptomatology (nausea, vomiting, abdominal distension). We present a case of 45-year-old women with feeding jejunostomy tube due to connatal anoxia. She arrives at A&E after 12 h of vomits and abdominal pain. The CT scan shows a small intestine dilation that suggested a small intestine volvulus. A laparotomy is performed showing a caecal volvulus, so ileo-cequectomy with primary anastomosis is performed. After several complications, she was discharged after 60 days of hospital stay. Caecal volvulus can be challenging to diagnose by clinic, because it can be hardly differenced from other intestinal occlusion causes. CT scan can be useful to reach the diagnostic and see signs of tissue suffering. In contrast with sigma volvulus, endoscopic treatment has not shown any benefit to solve it.
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Affiliation(s)
- A Morera-Grau
- General Surgery Department, Hospital del Mar, Barcelona, Spain
| | - E Membrilla-Fernández
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| | - A M González-Castillo
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | | | | | - J Guzmán-Ahumada
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| | - M Pera-Román
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| | - J J Sancho-Insenser
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
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27
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Shimoyama H, Ueno K, Samizo M. Successful treatment of adult cecorectal intussusception caused by cecum cancer with mobile cecum: a case report. Surg Case Rep 2021; 7:96. [PMID: 33856564 PMCID: PMC8050182 DOI: 10.1186/s40792-021-01180-0] [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: 03/10/2021] [Accepted: 04/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intussusception occurs when a segment of the bowel (the intussusceptum) telescopes into an adjacent segment (the intussuscipiens). Adult intussusception occurs rarely and often requires surgical resection for its treatment. We describe the case of an adult patient with extremely rare cecorectal intussusception treated using a novel combined transabdominal and trans-anal approach, which has not yet been reported in the literature. Case presentation A 71-year-old woman was transferred to our hospital for the treatment of upper abdominal pain. Physical examination, laboratory tests, and imaging inspections showed strangulated bowel obstruction induced by intussusception associated with the intra-rectal mass. We performed an emergency operation and treated the intussusception using a combined transabdominal and trans-anal approach. The intraoperative findings revealed bloody ascites and a potentially malignant tumor that had moved toward the anal side from peritoneal reflection. The tumor served as the lead point in the cecum with mobile cecum. After reducing the intussusception using the combined procedure, we removed the ileocecal portion. The intraoperative and histopathological findings suggested that cecum cancer with mobile cecum had caused the cecorectal intussusception. The patient had an uneventful postoperative course, except for postoperative pulmonary pneumonia. Conclusion To the best of our knowledge, this is the first reported case of adult cecorectal intussusception due to cecum cancer with mobile cecum successfully treated using the combined transabdominal and trans-anal approach. This combined procedure may be useful in treating the intussusception where the lead point is distal from the peritoneal reflection.
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Affiliation(s)
- Hayato Shimoyama
- Department of Surgery, Kobe Rosai Hospital, 4-2-23 Kagoikedori, Chuouku, Kobe, Hyogo, 651-0053, Japan. .,Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan.
| | - Kimihiko Ueno
- Department of Surgery, Kobe Rosai Hospital, 4-2-23 Kagoikedori, Chuouku, Kobe, Hyogo, 651-0053, Japan.,Department of Gastroenterological Surgery, National Hospital Organization Kobe Medical Center, 3-1-1, Nishiochiai, Sumaku, Kobe, Hyogo, 654-0155, Japan
| | - Masahiro Samizo
- Department of Surgery, Kobe Rosai Hospital, 4-2-23 Kagoikedori, Chuouku, Kobe, Hyogo, 651-0053, Japan.,Department of Surgery, Sanda City Hospital, 3-1-1 Keyakidai, Sanda, Hyogo, 669-1321, Japan
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28
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Khougali HS, Hamad Y, Abdelhamid A. Caecal volvulus associated with complex small bowel malrotation and congenital bands: A case report and literature review. J Surg Case Rep 2021; 2021:rjab040. [PMID: 33880170 PMCID: PMC8043257 DOI: 10.1093/jscr/rjab040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/25/2021] [Accepted: 03/17/2021] [Indexed: 11/14/2022] Open
Abstract
Caecal volvulus is an uncommon condition and represents only 10% of all colonic volvulus. The mechanism is due to hypermobile cecum twisting around it is own mesentery. A 40-year-old female who was previously fit and well-attended hospital with 2 days history of intermittent abdominal pain, mild distention and constipation. X-rays showed twisted and dilated loops of bowel with right hepato-diaphragmatic bowel loops entrapment. A computed tomography scan was the only confirmatory test of caecal volvulus with intermittent bowel symptoms. Emergency laparotomy revealed complex intraoperative bowel loops malrotation with congenital bands and abnormal position of Duodeno-Jejenal flexure. Open right hemicolectomy was the operation of choice for this complex case. Caecal volvulus must be considered as one of the important differential diagnosis of acute abdomen during initial assessment of patients with intermittent bowel symptoms in emergency department in order to avoid any therapeutic delay.
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Affiliation(s)
| | - Yousif Hamad
- Department of General Surgery, Worthing Hospital, Worthing, UK
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Kunishi Y, Tsukamoto M, Yanagibashi T, Sodani Y, Niwa K, Yoshie K, Kato Y, Maeda S. Cecal Volvulus Resolved Spontaneously. Intern Med 2021; 60:851-854. [PMID: 33055481 PMCID: PMC8024960 DOI: 10.2169/internalmedicine.5532-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/24/2020] [Indexed: 11/06/2022] Open
Abstract
Cecal volvulus is an uncommon cause of colonic obstruction. First-line treatment for cecal volvulus is surgery, as nonoperative management is rarely achievable. We herein report an extremely rare case of a patient with spontaneously resolved cecal volvulus; no recurrence occurred without elective surgery. A 47-year-old woman presented with acute lower abdominal pain. She was misdiagnosed with small bowel obstruction and treated conservatively. A few hours later, she was correctly diagnosed with cecal volvulus. Subsequently, her symptoms and computed tomography findings of cecal volvulus completely disappeared. She refused elective surgery, but no recurrence occurred during five months of follow-up.
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Affiliation(s)
- Yosuke Kunishi
- Department of Gastroenterology, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Megumi Tsukamoto
- Department of Gastroenterology, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Takafumi Yanagibashi
- Department of Gastroenterology, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Yuki Sodani
- Department of Gastroenterology, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Kazuhiro Niwa
- Department of Gastroenterology, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Koichiro Yoshie
- Department of Internal Medicine, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Yoshio Kato
- Department of Gastroenterology, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
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Kedrzycki MS, Roy Choudhury J, Hakky S. Caecal volvulus: untwisting the mystery. BMJ Case Rep 2021; 14:e237165. [PMID: 33692042 PMCID: PMC7949373 DOI: 10.1136/bcr-2020-237165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/03/2022] Open
Abstract
Caecal volvulus is an infrequent cause of acute surgical abdomen, where an abnormally mobile cecum twists on its own axis. It can lead to the development of closed-loop obstruction, small bowel ischaemia and perforation. Early recognition and prompt treatment is key; however, due to the rarity of this pathology, it is seldom listed as a differential diagnosis. Here, we present a single-centre case series of two patients presenting with caecal volvulus to an Emergency Surgery Unit at a University Hospital.
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Affiliation(s)
- Martha Sara Kedrzycki
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- General Surgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Hammersmith, London, UK
| | - Jaya Roy Choudhury
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- General Surgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Hammersmith, London, UK
| | - Sherif Hakky
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- General Surgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Hammersmith, London, UK
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Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis 2021; 23:476-547. [PMID: 33470518 PMCID: PMC9291558 DOI: 10.1111/codi.15503] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
AIM There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.
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Affiliation(s)
- Andrew S. Miller
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Benjamin Box
- Northumbria Healthcare Foundation NHS TrustNorth ShieldsUK
| | | | - Sarah E. Duff
- Manchester University NHS Foundation TrustManchesterUK
| | | | | | | | | | | | | | - Phil J. Tozer
- St Mark’s Hospital and Imperial College LondonHarrowUK
| | - Danette Wright
- Western Sydney Local Health DistrictSydneyNew South WalesAustralia
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Dholoo F, Shabana A, See A, Hameed W. Case-report: A rare cause of intestinal obstruction in late pregnancy. Int J Surg Case Rep 2020; 80:105391. [PMID: 33431333 PMCID: PMC7982489 DOI: 10.1016/j.ijscr.2020.11.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022] Open
Abstract
Caecal volvulus represents a rare and often life-threatening cause of intestinal obstruction, with associated high mortality rates. Diagnosis and early intervention remain a challenge, as patients may only present with vague nonspecific symptoms. More classical symptoms of volvulus eventually occur, usually secondary to obstruction or ischaemia. Early diagnosis and intervention are of paramount importance. We advise clinicians to remember this diagnosis, as a potential cause of abdominal pain and obstruction; especially in those with risk factors.
Introduction Caecal volvulus represents a rare and often life-threatening cause of intestinal obstruction. Diagnosis and management of caecal volvulus remains a clinical challenge, since those presenting with symptoms can have vague nonspecific presentations. Symptoms eventually occur, usually secondary to obstruction or ischaemia. This case report will discuss the presentation, investigation and management options available. Presentation A 31-year-old multigravida, at 38 weeks and 6 days gestation; presented to hospital with a 2-day history of diffuse abdominal pain and distension. Initial examination was unremarkable aside from mild epigastric tenderness. Raised inflammatory markers and concerns for foetal health resulted in an emergency caesarean section. Symptoms however worsened and the patient underwent colonoscopy and computerised tomography (CT) of the abdomen and pelvis with contrast; showing caecal volvulus. The patient was taken to the operating theatres for an emergency right hemicolectomy with formation of end ileostomy. Intra-operatively, areas of necrosis were noted within the caecum suggestive of impending perforation. The patient recovered well post reversal of end ileostomy, with no complications to date. Discussion Caecal volvulus represents a rare, but potentially fatal cause of intestinal obstruction and ischaemia. High mortality rates are attributed to delayed diagnosis and treatment. Patients may initially present with vague symptoms, which rapidly progress with the development of ischaemia. Multiple management modalities exist. Central to prognosis is early diagnosis. Conclusion Early diagnosis and intervention are paramount. Imaging via abdominal x-rays and CT are of particular importance. Surgical management is widely reported as the mainstay of treatment. We advise clinicians to remember this rare diagnosis, as a potential cause of abdominal pain and intestinal obstruction; especially in those with predisposing risk factors.
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Affiliation(s)
- Farzan Dholoo
- Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, General Surgery Department, Reading, UK.
| | - Amanda Shabana
- John Radcliffe Hospital, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Abbas See
- John Radcliffe Hospital, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Waseem Hameed
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, General Surgery, Berkshire, UK
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Ting YY, Farfus A, Trochsler M. Caecal volvulus in an incisional hernia. J Surg Case Rep 2020; 2020:rjaa422. [PMID: 33154811 PMCID: PMC7602695 DOI: 10.1093/jscr/rjaa422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/12/2020] [Indexed: 11/14/2022] Open
Abstract
Caecal volvulus represents 25-40% of all colonic volvulus. Symptoms include abdominal distension, constipation, nausea and vomiting where it may be intermittent. Abdominal X-rays and computed tomography (CTs) may help with diagnosis and recommended treatment is resection of mobile caecum. A 70-year old comorbid woman with previous open bariatric surgery and known incisional hernia presented with symptoms of bowel obstruction. CT showed caecal volvulus contained within the ventral hernia confirmed intra-operatively. Patient recovered well and was discharged on Day 6 of admission. This is the second case described in literature of a caecal volvulus occurring in an incisional hernia. The altered normal anatomy may have contributed to caecal mobility. Diagnosis of caecal volvulus can be challenging, more so in the presence of a more clinically apparent pathology. We present a second known case of caecal volvulus in a giant incisional hernia, where there were unique challenges to management.
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Affiliation(s)
- Ying Yang Ting
- Department of Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Anthony Farfus
- Department of Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Markus Trochsler
- Department of Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
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Pedraza Ciro M, Ramos JG, Geney MC, Moreno MD, Santafe Guerrero M, Vega P, Puerto D, Niño-González JE. Vólvulo del ciego, una entidad infrecuente como causa de abdomen agudo en embarazadas: Reporte de caso clínico y revisión de la literatura. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El vólvulo cecal en el embarazo es una patología infrecuente a nivel mundial, con un espectro clínico variado y limitación en estudios diagnósticos, lo que puede resultar en un desenlace ominoso.
Caso clínico. Se presenta el caso de una gestante en segundo trimestre del embarazo quien presenta abdomen agudo secundario a vólvulo cecal y sufrimiento fetal. La paciente fue llevada a cesárea de urgencia, donde además se practicó cecectomía y anastomosis íleo transversa, con mortalidad fetal.
Discusión. El vólvulo cecal forma parte de los diagnósticos diferenciales en caso de abdomen agudo durante el embarazo. Tiene un pronóstico reservado, en donde pueden presentarse desenlaces maternos y perinatales adversos, con mortalidad maternofetal.
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Wong M, Brooke Jeffrey R, Rucker AN, Olcott EW. Ileocolic vascular curvature: a new CT finding of cecal volvulus. Abdom Radiol (NY) 2020; 45:3057-3064. [PMID: 32221671 DOI: 10.1007/s00261-020-02491-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of a proposed new CT observation in cecal volvulus, marked hook-like curvature of ileocolic vessels termed "ileocolic vascular curvature." METHODS Contrast-enhanced CT scans of 14 patients with diagnoses of cecal volvulus on original CT reports were compared with scans of 40 control patients with dilated cecum but no cecal volvulus on original CT reports, accrued consecutively from January, 2006 through July, 2017. Two independent blinded readers retrospectively evaluated scans for cecal dilatation, ileocolic vascular curvature and seven previously reported CT features of cecal volvulus. Statistical methods included the exact binomial distribution to define 95% confidence intervals (95% CIs), logistic regression, receiver operating characteristic analysis, and the exact McNemar test. Pathology reports and clinical records served as reference standards. RESULTS All patients had abdominal pain and cecal distension. All 14 patients with CT diagnoses of cecal volvulus, and no control patients, had cecal volvulus by reference standards. Ileocolic vascular curvature and ectopic cecal location were the only features independently and significantly associated with cecal volvulus in multivariable regression (odds ratio 178, p = 0.014, and 63, p = 0.013, respectively) and also the only features with both sensitivity (12/14 [85.7%, 95% CI 57.2-98.2%] and 13/14 [92.9%, 95% CI 66.1-99.8%], respectively) and specificity (40/40 [100.0%, 95% CI 91.2-100.0%] and 38/40 [95.0%, 95% CI 83.1-99.4%], respectively) that differed significantly from 50.0%. CONCLUSIONS Ileocolic vascular curvature was independently and significantly associated with cecal volvulus and exhibited both substantial sensitivity and substantial specificity for cecal volvulus, and thus is potentially a valuable new CT finding of cecal volvulus.
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Affiliation(s)
- Margaret Wong
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA
| | - R Brooke Jeffrey
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA
| | - Adam N Rucker
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA
| | - Eric W Olcott
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA.
- Department of Radiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, USA.
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Aneja J, Varshney V, Ks S, Singhai K, Yadav T. Clozapine Triggering Cecal Volvulus in a Patient With Malrotation and Schizophrenia: Side Effect That Needs Emphasis. Cureus 2020; 12:e7971. [PMID: 32523828 PMCID: PMC7273366 DOI: 10.7759/cureus.7971] [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] [Indexed: 12/02/2022] Open
Abstract
Clozapine induced gastrointestinal hypomotility (CIGH) has been suggested as one of the most common causes of significant morbidity and mortality. It commonly presents as constipation, but the reports of other small or large intestinal complications with fatal outcomes are not uncommon. Hereby, we report the case of a 24-year-old male, suffering from schizophrenia and being managed with clozapine, who developed symptoms of acute intestinal obstruction due to ceco-colic volvulus. Subsequently, he was found to have intestinal malrotation at emergency laparotomy and underwent de-rotation of cecal volvulus and right hemicolectomy. He did well in the postoperative period and afterwards. Cecal volvulus which in itself is a rare cause of intestinal obstruction in adults has not been observed consequent to clozapine treatment and required surgical therapy.
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Affiliation(s)
- Jitender Aneja
- Psychiatry, All India Institute of Medical Sciences, Bathinda, IND.,Psychiatry, All India Institute of Medical Sciences, Jodhpur, IND
| | - Vaibhav Varshney
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Sreesanth Ks
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Kartik Singhai
- Psychiatry, All India Institute of Medical Sciences, Jodhpur, IND
| | - Taruna Yadav
- Radiology, All India Institute of Medical Sciences, Jodhpur, IND
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Bappayya S, Tsai HH, Bui H. Intermittent caecal volvulus: a rare cause of right iliac fossa pain in patients with previous right oophorectomy. ANZ J Surg 2020; 90:2577-2579. [PMID: 32353203 DOI: 10.1111/ans.15946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Shaneel Bappayya
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hao-Hsuan Tsai
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hai Bui
- Department of Surgery, Western Health, Melbourne, Victoria, Australia
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Abstract
Cecal volvulus is a rare cause of bowel obstruction in adults and an extremely rare presentation in children. One form known as a cecal bascule has only previously been reported in children with neurodevelopmental issues or with severe chronic constipation. We present the case of a 10-year-old boy who presented with an acute history of left lower quadrant abdominal pain, who upon investigation was found to have a cecal bascule.
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American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus. Gastrointest Endosc 2020; 91:228-235. [PMID: 31791596 DOI: 10.1016/j.gie.2019.09.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022]
Abstract
Colonic volvulus and acute colonic pseudo-obstruction (ACPO) are 2 causes of benign large-bowel obstruction. Colonic volvulus occurs most commonly in the sigmoid colon as a result of bowel twisting along its mesenteric axis. In contrast, the exact pathophysiology of ACPO is poorly understood, with the prevailing hypothesis being altered regulation of colonic function by the autonomic nervous system resulting in colonic distention in the absence of mechanical blockage. Prompt diagnosis and intervention leads to improved outcomes for both diagnoses. Endoscopy may play a role in the evaluation and management of both entities. The purpose of this document from the American Society for Gastrointestinal Endoscopy's Standards of Practice Committee is to provide an update on the evaluation and endoscopic management of sigmoid volvulus and ACPO.
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40
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Lewis A, Mahendiran S, Hochsztein J, Alterman D, Guelfguat M. An organized approach to imaging of benign cecal pathologies. BJR Open 2020; 2:20190043. [PMID: 33178964 PMCID: PMC7594902 DOI: 10.1259/bjro.20190043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/19/2019] [Accepted: 12/25/2019] [Indexed: 11/05/2022] Open
Abstract
Unique problems in cecal embryogenesis and cecal pathology can result in characteristic imaging findings. Familiarity with these findings and utilization of an organized approach help to define the cecum's role in acute abdominal symptoms. Clinical symptoms associated with cecal diseases can be diverse and misleading. This pictorial essay should provide a framework for an understanding of anatomical, infectious, and inflammatory cecal diseases. Knowledge of a broad spectrum of cecal pathologies contributing to these disorders and their corresponding imaging findings can help a radiologist define the diagnosis and guide proper management.
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Affiliation(s)
- Ariel Lewis
- Albert Einstein College of Medicine 1300 Morris Park Avenue Bronx, NY 10461, United States
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41
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Miyao M, Takahashi T, Okusa M, Kusakabe M, Takano R, Masuda Y, Kawashima M, Yoshida H. Recurrent Bowel Obstruction Caused by Cecal Volvulus: A Case Report. J NIPPON MED SCH 2019; 86:183-186. [PMID: 31292331 DOI: 10.1272/jnms.jnms.2019_86-308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The preoperative diagnosis of cecal volvulus (CV) is rare and difficult and emergent laparotomy is frequently performed. Here, we report a case of CV that was diagnosed by preoperative computed tomography in a patient with an intellectual disability. In addition, we demonstrate that elective laparoscopic cecopexy can be performed following conservative treatment, such as the use of an ileus tube per anus.
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Affiliation(s)
- Masaki Miyao
- Department of Pediatric Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Tsubasa Takahashi
- Department of Pediatric Surgery, Nippon Medical School Musashi Kosugi Hospital
| | | | | | | | - Yuka Masuda
- Department of Surgery, Nippon Medical School
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Zabeirou AA, Belghali H, Souiki T, Ibn Majdoub K, Toughrai I, Mazaz K. Acute cecal volvulus: A diagnostic and therapeutic challenge in emergency: A case report. Ann Med Surg (Lond) 2019; 48:69-72. [PMID: 31737261 PMCID: PMC6849140 DOI: 10.1016/j.amsu.2019.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Cecal volvulus is an uncommon cause of intestinal obstruction due to an axial twist of the caecum, ascending colon and terminal ileum around the mesenteric pedicle. It is responsible for 1%-1.5 of all intestinal obstructions in adult. The clinical signs may be highly variables and can be responsible of delays in diagnostic and treatment. The delay in diagnosis leads to intestinal necrosis or perforation. The mortality ranges from 10 to 40% depending on the presence of a viable or gangrenous intestine. Presentation of case A 64 year old woman admitted the emergency department for acute bowel obstruction. Clinical examination found typically acute bowel obstruction signs. Plain radiography showed dilated gas-filled segment of the colon in the left side of abdomen and volvulus of cecum was suspected. Enhanced abdominal CT scan confirmed the diagnosis. Emergency exploratory laparotomy was performed and confirmed the cecal volvulus. A manual untwisting of volvulus and a Caecopexy were performed. The patient subsequently recovered uneventfully and was discharged on postoperative day 3. Discussion The management of cecal volvulus requires prompt (emergency) diagnosis and prompt surgical intervention. Any delay in diagnosis may lead to intestinal necrosis or perforation and worsening the prognosis in patients who are generally elderly. Several authors reported a high mortality rate of cecal volvulus due to delay to diagnosis and surgical intervention. Conclusion The low incidence of this condition needs a high index of suspicion and emergency surgical management. Despite significant progress in medical imaging, the preoperative diagnosis of cecal volvulus is very difficult. As a result, the treatment is often delayed.
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Affiliation(s)
- Abdoul Aliou Zabeirou
- Department of General and Visceral Surgery, Hassan II University Hospital of Fez, 30050, Fez, Morocco
| | - Houssam Belghali
- Department of General and Visceral Surgery, Hassan II University Hospital of Fez, 30050, Fez, Morocco
| | - Tarek Souiki
- Department of General and Visceral Surgery, Hassan II University Hospital of Fez, 30050, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, 30050, Fez, Morocco
| | - Karim Ibn Majdoub
- Department of General and Visceral Surgery, Hassan II University Hospital of Fez, 30050, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, 30050, Fez, Morocco
| | - Imane Toughrai
- Department of General and Visceral Surgery, Hassan II University Hospital of Fez, 30050, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, 30050, Fez, Morocco
| | - Khalid Mazaz
- Department of General and Visceral Surgery, Hassan II University Hospital of Fez, 30050, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, 30050, Fez, Morocco
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43
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Walton S, Charalabopoulos A. A twisted tale. ANZ J Surg 2019; 89:1329-1330. [DOI: 10.1111/ans.14702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 04/25/2018] [Indexed: 11/30/2022]
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44
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Cho YM, Behrenbruch C, Tartaglia C, An V. Caecal herniation and volvulus through the foramen of Winslow: a rare presentation. ANZ J Surg 2019; 90:930-932. [PMID: 31533193 DOI: 10.1111/ans.15434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Yeo Min Cho
- Department of General Surgery, Eastern Health Victoria, Melbourne, Victoria, Australia
| | - Corina Behrenbruch
- Department of General Surgery, Eastern Health Victoria, Melbourne, Victoria, Australia
| | - Con Tartaglia
- Department of Radiology, Eastern Health Victoria, Melbourne, Victoria, Australia
| | - Vinna An
- Department of General Surgery, Eastern Health Victoria, Melbourne, Victoria, Australia
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45
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Negm Y. Two sisters with a rare cause of infantile colic. J Paediatr Child Health 2019; 55:924-927. [PMID: 30488515 DOI: 10.1111/jpc.14313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/11/2018] [Accepted: 10/28/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Infantile colic is a major parenthood challenge. For medical practitioners, even at the highest specialised levels, the management is never less challenging. This is a case report of two sisters who presented with typical symptoms of infantile colic. However, after a lengthy journey of workups, they were found to have a rare cause of those symptoms, requiring surgical repair. PRESENTING HISTORY A female baby born at term was initially diagnosed to have infantile colic. As the symptoms did not improve at the age of 3 months, she was referred to a paediatrician who switched her formula based on a provisional diagnosis of cows milk protein intolerance. With no relief of the baby's symptoms, this diagnosis was ruled out. Empirical treatment of gastro-oesophageal reflux was attempted. After the failure of this attempt, it was decided that the child's condition needs to be thoroughly investigated. PROGRESS Over 6 years, comprehensive investigations and relevant referrals at a tertiary paediatric gastroenterology centre have not helped to establish a definitive diagnosis or aetiology of the colic. Dietary modifications and various empirical medications have failed to cure the episodes, which exhausted the family, waking them up 10-20 times every night, leading to poor school attendance. TREATMENT A suggestion during a multidisciplinary meeting made a turning point. Definitive diagnosis and repair were established via laparoscopic surgery. FOLLOW-UP The child fully recovered following the surgical repair. Her sister, who was born with the same condition, was fortunate to be diagnosed and cured at a younger age.
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Affiliation(s)
- Yasser Negm
- Department of Paediatrics, Emirates Hospital, Dubai, United Arab Emirates
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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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Abdoolraheem MY, Quraishi MK, Tonsi A, Henderson A. Caecal volvulus following left-side laparoscopic retroperitoneal nephroureterectomy. BMJ Case Rep 2019; 12:12/7/e228878. [PMID: 31278197 DOI: 10.1136/bcr-2018-228878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Caecal volvulus is an uncommon cause of intestinal obstruction, with a high associated morbidity and mortality. Caecal volvulus is a very rare complication following retroperitoneal surgery. As such, a high degree of clinical suspicion is warranted post operatively to minimise delay in definitively investigating and managing this condition. We present a case of an 80-year-old Caucasian woman who was admitted for an elective left-sided laparoscopic retroperitoneal nephroureterectomy for transitional cell carcinoma of the left upper pole renal calyx. Postoperatively, the patient developed intestinal obstruction, secondary to caecal volvulus. The patient underwent an emergency laparotomy and limited right-sided colonic resection with primary anastomosis.
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Affiliation(s)
| | | | - Alfredo Tonsi
- General Surgery, Medway Maritime Hospital, Gillingham, Kent, UK
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Cecal bascule as a cause of postoperative nausea and abdominal pain. Radiol Case Rep 2019; 14:697-699. [PMID: 30976371 PMCID: PMC6439314 DOI: 10.1016/j.radcr.2019.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/09/2019] [Accepted: 02/11/2019] [Indexed: 12/27/2022] Open
Abstract
Cecal bascule is a unique form of large bowel volvulus in which the cecum folds anterior to the ascending colon and generates a flap valve which impairs cecal emptying and results in cecal dilation [1]. Presenting symptoms include nausea, vomiting, abdominal pain, distension, and constipation. We report a case of a 74-year-old male who developed abdominal pain and nausea after a coronary artery bypass graft surgery. Imaging demonstrated an enlarged cecum measuring up to 17.7 cm as well as upstream small bowel dilation. The patient underwent nasogastric tube and endoscopic decompression, relieving his cecal dilation and symptoms.
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Miura da Costa K, Saxena AK. A systematic review of the management and outcomes of cecal and appendiceal volvulus in children. Acta Paediatr 2018; 107:2054-2058. [PMID: 29949184 DOI: 10.1111/apa.14476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/09/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Abstract
AIM Appendiceal volvulus (AV) and cecal volvulus (CV) are rare conditions and there is no consensus regarding the best surgical approach. This study reviewed CV and AV management and outcomes in children. METHODS PubMed was reviewed from 1990 to 2018 for AV and CV in children and studies published in English were selected by two independent reviewers. This identified 24 papers that provided case reports on 29 children (72% male) with a median age of 10 years. RESULTS Abdominal distension and abdominal pain were the most common symptoms and seven children had Cornelia de Lange syndrome. The initial treatment was surgical in 27 cases and endoscopic in 2. In 23 children, variants of cecopexy were performed. There was no mortality. Complications occurred in seven cases: five with sepsis and two with enterocutaneous fistulas. There were three CV recurrences and these were all in cases where cecopexy was not performed. CONCLUSION AV and CV are rare paediatric pathologies. Since a quarter of the patients had Cornelia de Lange syndrome, it is paramount to consider CV when abdominal symptoms occur. Complications were minor with prompt management. In order to reduce recurrence, cecopexy is recommended in CV cases and appendectomy in AV cases.
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Affiliation(s)
- Karina Miura da Costa
- Department of Pediatric Surgery; Chelsea Children's Hospital; Chelsea and Westminster Hospital NHS Foundation Trust; Imperial College London; London UK
- Division of Pediatric Surgery; Department of Anatomy and Surgery; Ribeirão Preto Medical School; University of São Paulo; Ribeirão Preto Brazil
| | - Amulya Kumar Saxena
- Department of Pediatric Surgery; Chelsea Children's Hospital; Chelsea and Westminster Hospital NHS Foundation Trust; Imperial College London; London UK
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Abstract
Intestinal volvulus, regardless of location, is a rare disease process, but one that requires high suspicion and timely diagnosis given the increased incidence of intestinal necrosis and potential mortality. Most patients with intestinal volvulus require some form of surgical intervention. However, over the last few decades, the work-up and management of intestinal volvulus has changed given constant advancements in technology and patient care. Most importantly, however, is recognizing the need for emergent versus more elective surgery because this influences the morbidity and mortality for the individual patient.
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Affiliation(s)
- Zachary M Bauman
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
| | - Charity H Evans
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
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