International Journal of Advanced and Integrated Medical Sciences

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A rare case of isolated cecal volvulus with a congenital band
  IJAIMS
CASE REPORT
A rare case of isolated cecal volvulus with a congenital band
Manjul Mohan1, Amit Kukreti1, Himani Sharma2
1Department of Surgery, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India, 2Department of Radiodiagnosis,Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
Corresponding Author:
Amit Kukreti,Department of Surgery, RohilkhandMedical College and Hospital,Bareilly, Uttar Pradesh, India.
E-mail: amitkukreti28@gmail.com
Received: 12-02-2018
Accepted: 23-02-2018
Published: 16-06-2018
 
ABSTRACT
We present a typical case isolated cecal volvulus with the congenital band, leading tointestinal obstruction, which was managed surgically by resection and anastomosisalong with a diversion ileostomy. This is a rare entity caused by torsion of the cecumaround its mesentery. Hence, there is a definite need for observation after surgery.
KEY WORDS: Cecal volvulus, congenital band, intestinal obstruction
How to cite this article: Mohan M, Kukreti A, Sharma H.A rare case of isolated cecalvolvulus with a congenital band. IntJ Adv Integ Med Sci 2018;3(2):30-32.
Source of Support: Nil,
Conflicts of Interest: None
 
 

INTRODUCTION

One of the uncommon reasons for intestinal obstruction iscecal volvulus[1] which comes about due to self-rotating of thececum around its mesentery, leading to not passing of stooland flatus, that is an obstruction. After sigmoid volvulus, cecalvolvulus[2] is the next most common kind of colonic volvulus,representing 10-40% of all the colon-related volvulus. If onedoes not recognize the disease on time, then it can lead to gutperforation and fecal peritonitis. In common practice, incompletemalrotation is the basis for cecal volvulus to take place. Ifdiagnosed timely one can prevent deaths, taking place as a resultof a closed loop obstruction that with time leads to gut gangreneand perforation. Clinical features with which the patient presentscan be varied, which lead to delay in the diagnosis. The diseasehas a poor prognosis with a mortality rate of 0-40% based onbowel viability or gangrene.[1,3]

 
In this report, we exhibit a 65-year-old patie12 ptnt with cecalvolvulus with mobile cecum with a congenital band.

CASE REPORT

A 65-year-old male was brought to emergency with a history ofcolicky pain and lump over the suprapubic region, mimicking to thebladder from the past 2 days, with not passing flatus and stool from1 day. There was no previous history of a similar attack in the past.On examination, the abdomen was soft, with a well-circumscribedlump in the lower abdomen. Laboratory works were within normallimits. Plain abdominal X-ray and contrast computed tomography(CT) [Figures 1 and 2] of the abdomen confirmed the diagnosis ofa cecal volvulus with congenital band and malrotation of the gut.

The patient has consented for surgery, and an urgent laparotomywas performed after resuscitating the patient. Intraoperatively,we found a dilated cecum [Figure 3], with a stercoral ulcer at itsbase, with a long thick band wrapping cecum all around cecumand proximal ascending colon [Figure 4].

International Journal of Advanced & Integrated Medical Sciences, April-June, Vol 3, 201830

Mohan et al. A rare case of isolated cecal volvulus with a congenital band

The cecum was mobile with a proximal dilated ileum, andvisceral rotation was incomplete. A limited right hemicolectomywas performed, and an end-to-side ileocecal anastomosis wasdone [Figure 5]. Post-operative period was uneventful and thepatient did well. Histopathological examination reported thesame findings.

A rare case of isolated cecal volvulus with a congenital band
Figure 1: Contrast-enhanced computed tomography abdomencoronal image shows dilated cecum, suggestive of obstruction

A rare case of isolated cecal volvulus with a congenital band
Figure 2: Contrast-enhanced computed tomography abdomencoronal image reveals "whirlpool sign," showing twisting ofmesentery and engorged vessels, suggesting cecal volvulus

A rare case of isolated cecal volvulus with a congenital band
Figure 3: Intraoperative picture showing dilated cecum

 

DISCUSSION

The main cause for cecal volvulus is axial rotating of thececum with part of the terminal ileum and of ascendingcolon.[4] The annual incidence of gut obstruction due to cecalvolvulus is 2.8-7.1/million people, and the average age is53 years. The average age in India is 33 years.[5,6] Anatomicalcondition leading to cecal volvulus is a mobile, redundantcecum and a fixed point of rotation.[7] Pathophysiologically,there are three types, Type I - cecal volvulus taking placedue to axial torsion or twisting of the cecum along itsmesentery, including ascending colon and terminal ileum,Type II - loop volvulus taking place due to counterclockwiseaxial torsion of the cecum around its mesentery, includingthe ascending colon and terminal ileum, and Type III - cecalbascule involves the upward folding of the cecum ratherthan axial twisting. Types 1 and 2 together comprise 80% ofcases.[8,9] A mobile cecum and ascending colon are requiredfor all three types, whether congenital or acquired.[10,11]

A rare case of isolated cecal volvulus with a congenital band
Figure 4: Intraoperative picture showing stercoral ulcer at its base,with a long thick band

A rare case of isolated cecal volvulus with a congenital band
Figure 5: End-to-side ileocecal anastomosis

31International Journal of Advanced & Integrated Medical Sciences, April-June, Vol 3, 2018

Mohan et al. A rare case of isolated cecal volvulus with a congenital band

Congenital failure of fusion of ascending colon mesenteryand posterior parietal peritoneum is hypothesized to resultin cecal volvulus.[12,13] Other than all this, acquired anatomicabnormalities, such as surgical adhesions, congenital bandscan also contribute to the development of a cecal volvulus.Clinical features of cecal volvulus are highly variable, whichincludes intermittent colicky abdominal pain, to severe acutepain associated with sepsis and bowel strangulation, as aresult of ischemia to blood vessels due to obstructed, twistedmesenteric vessels.[14] Other common symptoms with whichthe patient presents are distension, constipation, obstipation,and vomiting which are usually a very late feature.Radiodiagnosis is the mainstay in the diagnosis of thiscondition, as laboratory investigations are neither sensitivenor specific to this condition. Plain X-rays, CT scan, andcontrast studies with water-soluble substance can diagnosethe disease. CT scan is confirmatory for diagnosis in 90%of cases.[10] Management includes surgery, which is righthemicolectomy or limited right hemicolectomy, like doneby us in our case, with the restoration of bowel continuityor resection and anastomosis with a proximal diversionileostomy if patient's general condition is poor. Canthopexywith appendectomy could be done if the patient's conditiondoes not allow resection.

CONCLUSION

The annual incidence of gut obstruction due to caecal volvulusis 2.8-7.1/million people, and it should be kept in mind in casepresenting with intermittent colicky abdominal pain, to severeacute pain associated with sepsis and bowel strangulation, as aresult of ischemia to blood vessels due to obstructed, twistedmesenteric vessels.

The annual incidence of gut obstruction due to cecal volvulus is2.8-7.1/million people, and the average age is 53 years.

 

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