Rare case of pediatric cecal volvulus

Explorative laparotomy of cecal volvulus in a pediatric patient. A case report and review of literature

INTRODUCTION AND IMPORTANCE

Cecal volvulus is a rare intestinal pathology that occurs due to abnormal cecum mobility associated with spectrum of complications. It is usually manifested in adults. However, on extremely rare occasions, it occurs in pediatrics. We presented a case of cecal volvulus demonstrating the significance of early diagnosis and treatment to reach successful outcomes.

CASE PRESENTATION

A 12 year old boy who presented to the emergency department for clinical evaluation for acute abdomen. History and clinical examination was suggestive of acute bowel obstruction. Abdominal x-ray showed a large, distended gas filled viscus with base pointed towards the right lower quadrant. On the bases of radiological investigations, diagnosis of cecal volvolus made. Accordingly, the patient underwent emergency exploratory laparotomy. The post operative course was uneventful and was discharged in stable condition.

CLINICAL DISCUSSION

Cecal volvulus is an extremely rare manifestation of intestinal obstruction and malrotation. The clinical presentation of cecal volvulus depending on the duration and extent of the involvement of cecal malrotation The exact pathogenesis of cecal volvulus is unclear. However the association of the embryological development of the colon, affects the attachment to the posterior parietal peritoneum after ordinary anatomical rotation of 270°. The core-stone management of cecal volvulus is surgical approach.

CONCLUSION

Cecal volvulus requires a high index of suspicion and delicate care by the pediatric surgeon as it is considered an extremely rare entity in this age group. We highlighted the significance of early diagnosis, surgical treatment and the possibility of developing postoperative complications if left untreated.

Caecal Volvulus: A District General Hospital Experience and Review of the Literature

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.

A Rare Case of Cecal Bascule in a Child With Normal Neurodevelopment

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.

A systematic review of the management and outcomes of cecal and appendiceal volvulus in children

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.

Diagnosis of pediatric gastric, small-bowel and colonic volvulus

Digestive volvulus affects the stomach, small bowel and mobile segments of the colon and often has a developmental cause. Reference radiologic examinations include upper gastrointestinal contrast series for gastric volvulus, possibly with ultrasonography for small-bowel volvulus, and contrast enema for colonic volvulus. Treatment is usually surgical. This pictorial essay describes the embryological development and discusses the clinical and radiologic presentation of volvulus, depending on location, and details the appropriate radiologic examinations.

A case of cecal volvulus presenting with chronic constipation in lissencephaly

Cecal volvulus is uncommon in pediatric patients and there are few reports of cecal volvulus with cerebral palsy. Here, we report the case of a 19-year-old male patient who presented with abdominal distension, a history of cerebral palsy, refractory epilepsy due to lissencephaly, and chronic constipation. An abdominal x-ray and computed tomography without contrast enhancement showed fixed dilated bowel intensity in the right lower abdomen. Despite decompression with gastric and rectal tube insertion, symptoms did not improve. The patient underwent an exploratory laparotomy that revealed cecal volvulus. Cecal volvulus usually occurs following intestinal malrotation or previous surgery. In this patient, however, intestinal distension accompanying mental disability and chronic constipation resulted in the development of cecal volvulus. We suggest that cecal and proximal large bowel volvulus should be considered in patients presenting with progressive abdominal distension combined with a history of neuro-developmental delay and constipation.

Volvulus of the appendix: a case report

Volvulus of the appendix is an uncommon phenomenon in children (J Can Med Assoc.1966;95:926-927). Only a few reports exist in the literature concerning this subject. We describe a 2-year-old child who presented with right lower quadrant abdominal pain and was initially diagnosed as ruptured appendicitis with abscess. Attempt at computed tomography-guided drainage failed to produce purulent drainage, and the child was taken to the operating room for diagnostic laparoscopy. Operative findings revealed a volvulus of the appendix, and a laparoscopic appendectomy was performed.