Cecal Volvulus Associated with Intestinal Malrotation Presenting as Postoperative Intestinal Obstruction

Abstract

Objective: To report a case of intestinal malrotation predisposing to cecal volvulus following nonabdominal surgery in an adult. Presentation and Intervention: A 23-year-old male with known anorectal malformation developed a postoperative intestinal obstruction following percutaneous nephrolithotomy for left renal calculus. Computed tomography of the abdomen revealed a grossly dilated cecum (9 cm) with ileocecal junction on the left side and small bowel loops on the right side of the abdomen. The patient underwent emergency exploratory laparotomy and retroperitonealization cecopexy. Bowel functions were normal at the follow-ups. Conclusion: This case highlights the importance of suspecting cecal volvulus even following nonabdominal surgery in the presence of predisposing factors.

Caecal Volvulus; A Rare Cause of Intestinal Obstruction.

“…9 Many factors have been referred as correlated to Caecal volvulus development, mainly anatomical predispositions such as incomplete intestinal rotation, and previous abdominal operations. 1,3,6,7 The disease predominantly affects female patients 30-60 years of age, as was in our case. 6 Abdominal pain, distension, nausea, vomiting, and diarrhea or constipation are the main clinical features of Caecal volvulus [1][2][3]6,7 , but unfortunately clinical symptoms, signs, and routine laboratory tests are not specific enough to lead to a prompt diagnosis.…”

“…1,3,6,7 The disease predominantly affects female patients 30-60 years of age, as was in our case. 6 Abdominal pain, distension, nausea, vomiting, and diarrhea or constipation are the main clinical features of Caecal volvulus [1][2][3]6,7 , but unfortunately clinical symptoms, signs, and routine laboratory tests are not specific enough to lead to a prompt diagnosis. 3 Although abdominal radiography may show the features of an intestinal obstruction, including wide-spread small intestinal airfluid levels and/or distended cecum in the right abdomen, making the Caecal volvulus diagnosis is difficult or impossible in most of the cases 2, 3,6 , as was in ours.…”

“…Doppler USG may lead to make a definite diagnosis by showing twisted mesenteric vessels 6 , and CT may be more diagnostic by demonstrating Caecal distension, Caecal apex in left upper quadrant, mesenteric whirl, ileocecal twist, an small bowel distension. 7 Despite the identified diagnostic features, Caecal volvulus is rarely diagnosed correctly at the time of presentation due to the low incidence of the disease.…”

Cecal Volvulus: A Rare Cause of Intestinal Obstruction

“…Many factors have been referred as correlated to cecal volvulus development, mainly anatomical predispositions such as incomplet intestinal rotation, and previous abdominal operations [1,3,6,7]. The disease predominantly affects female patients 40-60 years of age, as was in our case [6].…”

“…Although abdominal radiography may show the features of an intestinal obstruction, including widespread small intestinal air-fluid levelsand/or distended cecum in the right abdomen, making the cecal volvulus diagnosis is difficult or impossible in most of the cases [2,3,6], as was in ours. Doppler USG may lead to make a definite diagnosis by showing twisted mesenteric vessels [6], and CT may be more diagnostic by demonstrating cecal distension, cecal apex in left upper quadrant, mesenteric whirl, ileocecal twist, and small bowel distension [4,7]. Despite the identified diagnostic features, cecal volvulus is rarely diagnosed correctly at the time of presentation due to the low incidence of the disease [2,3].…”