A 64-year-old woman presented to the emergency room with abdominal pain of increasing intensity in recent hours, associated with abdominal discomfort and constipation.
As a personal history only mentions being victimized.
The exploration revealed a large abdominal disk with tympanism and generalized pain.
Blood tests showed leukocytosis with left shift.
An abdominal CAT scan showed a large cecum dilation of more than 10 cm in diameter attributable to a mechanical cause without any mass or tumor.
The rest of the abdominal organs, as well as the loops of the ileum and/or iliac not seem to present alterations.
Urgent surgical intervention was decided. A supra-inumbilical midline laparotomy was performed. A large gap was observed in the cecum diameter of about 14 cm as a consequence of a volvulus-affection, which was fixed.
1.
Adherence was released and right hemicolectomy was performed with manual laterolateral anastomosis.
Postoperatively, the patient developed a prolonged paralytic ileus that was managed medically and was discharged on the 9 postoperative day.
The intestinal volvulus is caused by the torsion of a mobile segment of the colon around its mesenteric axis; it is more frequent in sigmoid colon%), followed by the cecum (15%) and transverse (5%) (1).
In the specific case of the cecal volvulus, there is a rotation around the ileocolic artery (2).
It is an uncommon cause of intestinal obstruction in the West, but not in Africa, Asia or South America, where it is common to find it (3).
Factors that influence the development of colonic volvulus have been described, such as diet rich in residues, chronic constipation and laxative abuse, Chagas disease, disabling neurological diseases, pregnant women,...
(3).
In our case, in addition to the weakness of the month, the previous intervention in the right iliac fossa was probably the most important ethiopathogenic factor in volvulus.
The symptoms usually present as a characteristic triad: pain, dysrhythmia and constipation, which are usually followed by nausea and vomiting and, if the volvulus does not occur, the colonic peritonitis may develop.
As a diagnosis, although radiography may show a characteristic image of coffee beans, abdominal CT is the most specific test.
The colonic mucosa is sometimes useful (2).
Treatment can be conservative, with placement of a vacuum assisted closure (4), or barium enema (the method of choice for sigmoid volvulus prior to surgery, but is less effective in the right hemicolumn.)
Other techniques such as cecopexia or cecostomy have been described, as well as the laparoscopic approach to this pathology (5,6).
Mortality of cecal volvulus varies from 10% if the colon is viable to 40% if there is intestinal metaplasia (4).
1.
R. M. Jiménez Rodríguez, J. M. Díaz Pavón, I. Alarcón del Agua, C. Bernardos García, J. M. Álamo Martínez and Jque
Department of General Surgery and Gastroenterology.
Hospital Universitario Virgen del Rocío.
Sevilla
