Caecal volvulus in a 35-year-old man: a case report.

Caecal volvulus is a rare cause of mechanical bowel obstruction (1-1.5%) that carries a high mortality rate if diagnosis or surgical intervention is delayed. We report a 35-year-old man who presented with acute colicky abdominal pain, vomiting, and constipation for the past 18 hours. A plain abdominal X-ray showed distended large bowel loops with two large well-defined air-fluid levels superimposed on each other, suggestive of caecal volvulus. The patient underwent emergency laparotomy, and the intraoperative finding confirmed the diagnosis of gangrenous extended caecal volvulus, which involves the terminal ileum, cecum, and the whole of the ascending colon. A right hemicolectomy was performed, and bowel continuity was restored by primary ileotransverse anastomosis. The patient recovered without complications and was discharged on postoperative day 6. In conclusion, caecal volvulus is a rare cause of adult intestinal obstruction. Early diagnosis and surgical intervention can prevent perforation and reduce morbidity related to volvulus perforation.

An Unusual Combination of Arthrogryposis, Gastroschisis, Cecal Volvulus, and Malignant Hyperthermia in a Young Woman: A Case Report.

BACKGROUND The purpose of this study is to discuss a patient with a history of conditions, including arthrogryposis, gastroschisis, and malignant hyperthermia, who presented with cecal volvulus requiring urgent surgical intervention. CASE REPORT A 29-year-old woman with a history of arthrogryposis, gastroschisis, malignant hyperthermia, and multiple childhood abdominal surgeries presents to the Emergency Department (ED) with 2 days of abdominal pain and bloody diarrhea. A CT abdomen/pelvis revealed findings concerning for a cecal volvulus. The patient was premedicated and monitored closely by the anesthesia team due to her history of malignant hyperthermia. She underwent an exploratory laparotomy, where a dilated cecum and proximal ascending colon were found to be completely volvulized around the mesentery. Manual bowel detorsion was performed, which resulted in reperfusion of the ischemic-appearing bowel, which then appeared viable. She recovered well after the procedure and was discharged on postoperative day 5. CONCLUSIONS This case highlights a patient who presented with a combination of 4 findings: arthrogryposis, gastroschisis, malignant hyperthermia, and cecal volvulus. With arthrogryposis reported to be associated with gastroschisis and malignant hyperthermia, this report not only corroborates this association, but also aims to draw attention to the fact that these conditions have potential to occur jointly with cecal volvulus. Given the patient's history of gastroschisis requiring extensive abdominal surgeries that contribute as risk factors for cecal volvulus, it is possible there may be other arthrogryposis patients who present with cecal volvulus similar to that seen in this patient.

Rare Pediatric Cecal Anomalies: A Lesson in Pediatric Surgery.

BACKGROUND: Rare incidence cases are part of the routine work of pediatric surgeons. Cecal anomalies in children are an example of such cases. Objectives: To describe the presentation, workup, management and outcome of rare cecal anomalies in children and to analyze the skills needed for their successful treatment. METHODS: A retrospective chart review was conducted of all cases of cecal anomalies managed by the pediatric surgical service at a tertiary hospital from June 2017 to January 2020. Data regarding demographics, clinical presentation, radiological studies, surgical treatment, pathology, complications, and outcome were collected. RESULTS: Five cases of cecal anomalies were encountered over a period of 32 months, including a cecal volvulus, cecal duplication, cecal intussusception, and two cecal masses (one ulcerated lipoma and one polyp). All patients, except the patient with cecal duplication, presented acutely and were managed surgically. Long-term follow-up of 17-24 months was unremarkable in all cases. CONCLUSIONS: A wide knowledge base, careful judgment, and creativity enable pediatric surgeons to successfully treat rare conditions such as rare cecal anomalies. These skills should be part of the education of pediatric surgery trainees.

[Cecal volvulus: one case and literature review]. / Vólvulo cecal: un caso y revisión de la literatura.

Background: Cecal volvulus is a rare disease that causes intestinal obstruction. It has various congenital and acquired risk factors. It is frequently associated with abnormal cecal fixation, and it is caused by torsion of the cecum in one of its three axes. It is not different from other causes of intestinal obstruction, but a delay in its diagnosis can lead to ischemia, necrosis and colon perforation. Its management depends on the viability of the tissues, ranging from untwisting and cecopexy to hemicolectomy with or without anastomosis. We present a case of caecal volvulus (caecal bascule) and review the literature as well. Clinical case: 43-year-old female, who was admitted to an emergency department with data of intestinal obstruction. A simple tomography of the abdomen was performed, where a dilated colon and an image that resembles an inverted coffee bean were identified. An exploratory laparotomy was performed, identifying a bascule-type cecal volvulus, without vascular compromise. Devolvulation, decompression through appendectomy, and caecopexy were performed. After the surgical event, the patient recovered without incident and was discharged with adequate controls by external consultation. Conclusions: Cecal volvulus is a cause of intestinal obstruction with a low incidence, which is why early recognition and treatment are key to avoiding the complications that its evolution entails. This type of disease should be among our differential diagnoses, since treatment is surgical and delay leads to a high mortality rate.

Introducción: el vólvulo cecal es una enfermedad poco común que causa obstrucción intestinal. Tiene diversos factores de riesgo congénitos y adquiridos. Se suele asociar a una fijación cecal anormal y se produce por la torsión del ciego en alguno de sus tres ejes. No se diferencia de otras causas de obstrucción intestinal, pero un retraso en su diagnóstico puede derivar en isquemia, necrosis y perforación del colon. El manejo depende de la viabilidad de los tejidos y va desde la destorsión y cecopexia hasta la hemicolectomía con o sin anastomosis. Se presenta un caso de vólvulo cecal (báscula cecal) y se hace una revisión del tema. Caso clínico: mujer de 43 años que ingresó a un servicio de urgencias con datos de obstrucción intestinal. Se realizó tomografía simple de abdomen donde se identificó dilatación del colon e imagen que semejaba un grano de café invertido. Se hizo laparotomía exploradora y se identificó vólvulo cecal del tipo báscula, sin compromiso vascular. Se realizó desvolvulación, descompresión a través de apendicectomía, y cecopexia. Posterior a evento quirúrgico, la paciente se recuperó sin incidentes y fue dada de alta con controles adecuados por consulta externa. Conclusiones: el vólvulo cecal es una causa de obstrucción intestinal con baja incidencia, por lo que el reconocimiento y tratamiento precoz son claves para evitar las complicaciones que conlleva su libre evolución. Este tipo de enfermedad debe de estar entre nuestros diagnósticos diferenciales, ya que el tratamiento es quirúrgico y el retraso conlleva a una alta tasa de mortalidad.

Intususcepción apendicular por foco endometriósico: un caso clínico / Appendiceal intussusception caused by endometriosis: a clinical case

Resumen Objetivo: Reportar el caso de una paciente con intususcepción apendicular (IA), condición infrecuente, secundario a foco de endometriosis, patología que en los últimos años ha presentado un aumento en su incidencia. Material y Método: Historia clínica, imágenes preoperatorias e intraoperatorias obtenidas de la ficha clínica. Resultados: Mujer de 35 años con dolor abdominal crónico de 4 meses de evolución. Se realiza estudio colonoscópico evidenciando lesión de 15 x 8 mm en ostium apendicular intususceptada al lumen cecal, y enteroclisis por tomografía axial computarizada (TC) que confirma IA. Se realiza una resección ileocecal laparoscópica demostrando la invaginación del apéndice con biopsia que muestra un foco de endometrioma. Discusión: La IA es una condición infrecuente con una incidencia cercana al 0,01% en la población general. Las patologías benignas son la principal causa (77%), siendo la endometriosis la causa más frecuente. Conclusión: La IA por endometriosis es anecdótica, con sintomatología poco específica. Los estudios disponibles pueden orientar adecuadamente la presencia de IA, sin embargo, en algunas ocasiones puede confundirse con patologías neoplásicas, donde cobra importancia la cirugía para dilucidar la etiología.

Objective: To report the case of a patient with appendicular intussusception (AI), an infrequent condition secondary to a focus of endometriosis, a pathology that has increased incidence in recent years. Material and Method: Clinical case, history and images obtained from the clinical file and intraoperative records with the consent of the patient. Results: A 35-year-old woman with abdominal pain. Colonoscopy study showing a 15 × 8 mm lesion in the appendicular ostium intussuscepted to the cecal lumen, and a computerized tomography (CT) enteroclysis confirming AI. A laparoscopic ileocecal resection is performed, demonstrating invagination of the appendix secondary to an endometrioma focus. Discussion: AI is a rare condition, with an incidence close to 0.01% in the general population. Benign pathologies are the main cause (77%), endometriosis being the most frequent cause. Conclusion: AI due to endometriosis is anecdotal, with unspecific symptoms. The available studies can adequately guide the presence of AI, however, on some occasions it can be confused with neoplastic pathologies, where surgery is important to elucidate the etiology.

Post-operative Cecal Volvulus After Extensive Mobilization of the Right Colon During Laparoscopic Appendectomy.

Cecal volvulus can be a rare and challenging diagnosis. We report a 47-year-old female who presented to the hospital and was diagnosed with acute appendicitis based on workup and clinical exam. The patient underwent laparoscopic appendectomy where the appendix was localized after extensive ascending colon mobilization. The patient's post-operative course was complicated by cecal volvulus requiring a right hemicolectomy. There have been several other reported cases of cecal volvulus following laparoscopic appendectomy, both of which also involved considerable cecal mobilization. More data are necessary to determine whether this clinical course could have been prevented with more limited mobilization or with cecopexy at initial surgery. A mobilized cecum may benefit from early surgical intervention to prevent future volvulus or a chronic mobile cecum syndrome. Cecal volvulus should be considered in the case of worsening abdominal pain or obstruction following laparoscopic appendectomy, given the consequences that can result if symptoms are overlooked.

[A Case of Appendiceal Intussusception Induced by Early Appendiceal Carcinoma].

Appendiceal intussusception is an uncommon pathologic condition. We report herein a case of appendiceal intussusception induced by appendiceal carcinoma. A 76-year-old woman was admitted to hospital because of epigastric pain. CT scan showed multiple concentric ring sign in ascending colon and enhanced tumor in transverse colon. Colonoscopy showed invagination of polypoid lesion which was pushed back to cecum endoscopically. Laparoscopy-assisted ileocecal resection with regional lymph node dissection was performed for cecal cancer. During surgery, the appendix was found to be inverted completely into the cecum. The tumor was 70×35 mm in size in the cecal cavity, and the appendix had completely invaginated into the cecum at its base. Histopathologic examination revealed early appendiceal carcinoma. The patient is healthy without recurrence.

Concussion of the colon: paediatric patient with traumatic cecal haematoma.

A 14-year-old boy was injured from playing football, and subsequently developed worsening abdominal pain. CT of the abdomen and pelvis was concerning for a mass of ascending colon, with free fluid in the pelvis. The patient was emergently taken to the operating room where he was found to have a cecal haematoma. The patient underwent a right hemicolectomy and ileocolostomy and was discharged home just days later without any acute complications. As cecal haematomas are a rare entity, the best approach to management is not well defined. When the diagnosis is uncertain, or if the possibility of full-thickness injury exists, exploratory laparoscopy or laparotomy is the safest approach.

Colorectal surgery obesity-related morbidity during COVID-19.

Tocilizumab, a monoclonal antiinterluekin-6 receptor antibody, has been empirically used in the treatment of cytokine release syndrome associated with severe coronavirus disease 2019 infections. The efficacy and safety of these medications for these patients is unknown. The purpose of this report was to present a case of acute large bowel perforation in a morbidly obese patient with coronavirus disease 2019 pneumonia who received empiric Tocilizumab. This case report analyzes the risks of acute large bowel perforation after using this medication empirically and discusses the appropriate management of this adverse event.

Appendicular and Caecal Fecalith causing Perforation: A Case Report.

Fecalith is a concretion of dry compact feces or hard stony mass of faeces in the intestinal tract. Though appendicular fecoliths are commonly encountered, caecal fecoliths are rare entities. Fecoliths are amenable to conservative management with laxatives and enemas but surgical management prevents recurrence. We present a case of 27 years old male who was diagnosed with acute appendicitis with peritonitis. He was intraoperatively diagnosed as gangrenous and perforated retrocaecal appendix with multiple small fecaliths and a large fecalith on cecum with perforation. Appendectomy and primary repair of caecal perforation done. Histological examination of perforated margin confirmed as an inflammatory lesion.

Cecal distension on non-tumoral left colonic obstacle: Management strategy in two cases.

Diastatic damage of the caecum is only described in left colon neoplastic obstructions. However, diverticular sigmoid stenosis can likely cause cecal diastatic distention. In emergency, ileo-cecal resection removing the area of diastatic damage or externalizing the cecal perforation can be an interesting alternative to subtotal colectomy. The left colonic stenosis is treated later so the colon can be spared with better long-term functional outcome than after subtotal colectomy.

Appendix intussusception in a young patient with Crohn's disease.

Appendix intussusception is rare, can be responsible of chronic unexplained abdominal pain and is mostly associated with inflammatory changes or endometriosis. A 23-year-old woman with Crohn's disease was diagnosed invaginated appendix by CT-scan and colonoscopy after several acute atypical abdominal pain episodes. These episodes were suspected to be independent of the Crohn's disease and to be attributed to the intussusception itself. A resection combining ligation of the base by colonoscopy and cecectomy by laparoscopy was performed successfully. However, no argument for Crohn's disease was found on the pathologic examination.