Understanding A Case Of Cecal Volvulus
Cecal volvulus is axial twisting that occurs involving the cecum, terminal ileum, and ascending colon. Rarely, it may take the form of upward and anterior folding of the ascending colon (“cecal bascule”).
The research team led by Prof. Hiroshi Suzuki from Toyama Hospital reported a case of caecal voluvuls seen in a 78-year-old woman and reviewed of Japanese literature. This will be published in May 28, 2009 in the World Journal of Gastroenterology addresses this issue.
A 78-year-old woman presented with fever, severe abdominal pain, and distension. She had been institutionalized for depression and senile dementia. Laboratory examinations disclosed a leucocytosis (WBC: 12500/Ãž¼L) and elevated levels of serum C-reactive protein (2.8 mEq/L). Diagnosis of acute cecal volvulus was made from a “coffee bean sign” on an abdominal computed tomography and a “beak sign” on a gastrographin enema. An emergent laparotomy confirmed the diagnosis and an ileo-colectomy with primary anastomosis was carried out. The patient recovered after intensive respiratory care and fluid therapy, and then returned to her former institution. A review of Japanese literature disclosed that: (1) a marked increase of aged patients with mental disability presenting with cecal volvulus, (2) adoption of ileo-colectomy as the standard surgical procedure, and (3) improved survival of the patients, were observed in the last decade.
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