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Jeo WS, Prawirodihardjo MMP, Putranto AS, Mazni Y. Caecopexy as management for caecal volvulus: An evidence-based case report. Int J Surg Case Rep 2023; 111:108862. [PMID: 37776685 PMCID: PMC10556757 DOI: 10.1016/j.ijscr.2023.108862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The incidence of caecal volvulus (CV) reaches 2.8-7.1 per million per year. CV is a surgical emergency that must be treated immediately because the mortality rate can reach 30 %, and the recurrence rate is 40 %. This study showed a case illustration of caecal volvulus with evidence-based recommendations for indications and management of caecopexy based on postoperative outcomes. CASE PRESENTATION 33-Year-old male came with chief complaints of persistent acute abdominal pain one day before hospital admission. Pain is felt suddenly throughout the abdomen. On physical examination, palpable pain in the entire abdomen is obtained, accompanied by the muscular defence with increased bowel sounds. The laboratory only showed increased white blood cells. Abdominal computed tomography (CT) with contrast showed closed-loop obstruction (CLO) signs. CLINICAL DISCUSSION Caecopexy technique use is supported in a case series because it can be done safely, quickly, and without the need to open intestinal segments. Based on previous researches, there were none to low rate of morbidity, mortality, and recurrence. In this patient, caecopexy was carried out and showed good output with no complications. CONCLUSION Caecopexy is a safe, simple, and less invasive procedure. The advantages of the caecopexy technique are low morbidity, mortality, and recurrence. The patient's outcome in this illustration is consistent with other literature. Thus it can be used as evidence-based recommendations in the management of the next case of caecal volvulus.
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Affiliation(s)
- Wifanto Saditya Jeo
- Division of Digestive Surgery, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
| | | | - Agi Satria Putranto
- Division of Digestive Surgery, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Yarman Mazni
- Division of Digestive Surgery, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Kreinces J, Robbins AI, Kim DE. Cecal bascule in pregnancy: a case report and review of the literature. J Surg Case Rep 2023; 2023:rjad287. [PMID: 37234082 PMCID: PMC10206289 DOI: 10.1093/jscr/rjad287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/01/2023] [Indexed: 05/27/2023] Open
Abstract
A 36-year-old female at 36 weeks' gestation presented with right upper quadrant abdominal pain. She had no prior surgeries. Her pregnancy had been uncomplicated up until her presentation. Abdominal ultrasound was negative for cholecystitis or cholelithiasis, and the appendix was not visualized. During the second day of her hospital course, an abdominal magnetic resonance imaging (MRI) was performed revealing dilated small intestine with air-fluid levels and an inverted-appearing, prominent cecum. She was urgently taken to the operating room for cesarean section followed by abdominal exploration. After delivery of the child, a cecal bascule was found, with a severely distended cecum. To our knowledge, this is the first report of a cecal bascule diagnosed by MRI, and the first diagnosis of cecal bascule in a pregnant patient requiring surgical intervention. We discuss the pathophysiology, diagnosis and treatment of cecal bascule and review the current literature of reported cases.
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Affiliation(s)
- Jason Kreinces
- New York Medical College School of Medicine, Valhalla, NY 10595, USA
| | - Alicia I Robbins
- Department of Obstetrics and Gynecology, Greenwich Hospital, Greenwich, CT 06830, USA
| | - Daniel E Kim
- Correspondence address. Greenwich Hospital, Yale New Haven Health, 5 Perryridge Road, Suite 2-3200, Greenwich, CT 06830, USA. Tel: +1-203-863-4300; Fax: +1-203-863-4310; E-mail:
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3
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Reinke CE, Lim RB. Minimally Invasive Acute Care Surgery. Curr Probl Surg 2021. [DOI: 10.1016/j.cpsurg.2021.101033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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4
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Reinke CE, Lim RB. Minimally invasive acute care surgery. Curr Probl Surg 2021; 59:101031. [DOI: 10.1016/j.cpsurg.2021.101031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/16/2021] [Indexed: 12/07/2022]
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Mazine K, Elbouhaddouti H, Toughrai I, Mouaqit O, Benjelloun E, Ousadden A, Taleb KA. [Volvulus of the cecum: a rare cause of intestinal occlusion: about two cases]. Pan Afr Med J 2018. [PMID: 29541308 PMCID: PMC5847055 DOI: 10.11604/pamj.2017.28.162.12237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Le Cæcum est, en fréquence, la deuxième partie du colon concernée par le volvulus après le sigmoïde et avant l'angle gauche et le côlon transverse. Cette affection survient sur des cæcums anormalement mobiles. Le mécanisme du volvulus est la torsion ou la bascule. Le tableau clinique est celui d'une occlusion intestinale aiguë par strangulation. L'abdomen sans préparation (ASP) et la TDM abdominale sont les examens radiologique de premier choix pour le diagnostic. Le traitement consiste en une chirurgie en urgence avec résection du cæcum et de l'iléon terminal. Nous rapportons deux cas de volvulus du cæcum admis aux urgences dans un tableau d'occlusion intestinale aiguë, le diagnostic était confirmé chez les deux patients par un scanner abdomino-pelvien et le traitement consistait en une résection iléo-colique avec rétablissement immédiate de continuité, les suites post opératoires étaient simples.
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Affiliation(s)
- Khalid Mazine
- Service de Chirurgie Viscérale A(C3), CHU Hassan II, Fès, Maroc
| | | | - Imane Toughrai
- Service de Chirurgie Viscérale B(E3), CHU Hassan II, Fès, Maroc
| | - Ouadie Mouaqit
- Service de Chirurgie Viscérale A(C3), CHU Hassan II, Fès, Maroc
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Kagawa Y, Kato T, Naito A, Morimoto Y, Sato Y, Kuwahara R, Ishida T, Oneda Y, Murakami K, Inatome J, Katsura Y, Ohmura Y, Takeno A, Egawa C, Takeda Y, Tamura S. Single-site laparoscopic right hemicolectomy for acute cecal volvulus: a case report. Surg Case Rep 2016; 2:51. [PMID: 27230653 PMCID: PMC4882310 DOI: 10.1186/s40792-016-0179-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cecal volvulus is an uncommon cause of acute abdomen in patients. Cecal volvulus is currently treated mostly with right hemicolectomy with laparotomy, which is an invasive surgical procedure. Less invasive techniques, such as endoscopic decompression, have a poor success rate. CASE PRESENTATION We report a case of cecal volvulus in a 35-year-old male patient. He was successfully treated with single-site laparoscopic decompression by inserting a catheter through the amputated appendix, detorsion, and hemicolectomy. This approach was less invasive than the traditional approach and resulted in satisfactory outcomes and cosmesis. CONCLUSIONS Application of single-site laparoscopic colectomy to acute cecal volvulus is feasible using decompression of the dilated colon by inserting a catheter through the amputated appendix. To the best of our knowledge, this is the first report of this treatment.
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Affiliation(s)
- Yoshinori Kagawa
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
| | - Takeshi Kato
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Atsushi Naito
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | | | - Yasufumi Sato
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Ryuichi Kuwahara
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Tomo Ishida
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Yasuo Oneda
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Kohei Murakami
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Junichi Inatome
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Yoshiteru Katsura
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Yoshiaki Ohmura
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Chiyomi Egawa
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Yutaka Takeda
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Shigeyuki Tamura
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
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Ishida Y, McLean SF, Tyroch AH. Cecal bascule after spinal cord injury: A case series report. Int J Surg Case Rep 2016; 22:94-7. [PMID: 27077698 PMCID: PMC4844695 DOI: 10.1016/j.ijscr.2016.03.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/24/2016] [Accepted: 03/24/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction Cecal bascule is a rare cause of intestinal obstruction associated with upward and anterior folding of the ascending colon. We report three patients who presented with spinal cord injury complicated with a cecal bascule. Diagnosis and management of cecal bascule is discussed. Presentation of cases Patient 1: 59-year-old male sustained a traumatic brain injury and cervical spinal cord injury after a motorcycle crash. He had abdominal distension and the diagnosis of cecal bascule was made. Cecopexy was performed. Patient 2: 51-year-old male sustained an unstable C7 vertebral fracture with a cord contusion and quadriplegia after a diving incident. After an unsuccessful medical management of the colonic distension, the patient was taken for a laparotomy and cecal bascule was found. A cecostomy and a cecopexy were performed. Patient 3: 63-year-old male was transferred after a fall. He had diffuse degenerative changes in the thoracic and lumbar spine. He was found to have a perforated cecal bascule. He had a right hemicolectomy with an ileocolic anastomosis. Discussion We suggest the possibility of spinal cord injury being a risk factor for cecal bascule. Currently, right hemicolectomy is recommended for the treatment of cecal bascule. Cecopexy is also acceptable treatment option for a case in which the patient will be undergoing an operation with an insertion of hardware. Conclusion The diagnosis of cecal bascule should be considered for trauma patients with cecal distention without delay in order to prevent disastrous complications.
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Affiliation(s)
- Yuichi Ishida
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, Department of Surgery, 4800 Alberta Ave., El Paso, TX 79905, United States.
| | - Susan F McLean
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, Department of Surgery, 4800 Alberta Ave., El Paso, TX 79905, United States
| | - Alan H Tyroch
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, Department of Surgery, 4800 Alberta Ave., El Paso, TX 79905, United States
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Narjis Y, Rabbani K, Largab S, Soumani A, Finech B, El Idrissi Dafali A. Coecal volvulus: An acute complication of pregnancy. J Emerg Trauma Shock 2011; 3:426-7. [PMID: 21063579 PMCID: PMC2966589 DOI: 10.4103/0974-2700.70771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Youssef Narjis
- Department of General Surgery, Universitary Hospital Mohamed VI, Cadi Ayyad University, Marrakesh, Morocco
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Abstract
This report indicates that laparoscopic techniques may be a safe approach for acute colonic volvulus. Background: Metachronous colonic volvulus is a rare event that has never been approached laparoscopically. Methods: Here we discuss the case of a 63-year-old female with a metachronous sigmoid and cecal volvulus. Results: The patient underwent 2 separate successful laparoscopic resections. Discussion and Conclusion: The following is a discussion of the case and the laparoscopic technique, accompanied by a brief review of colonic volvulus. In experienced hands, laparoscopy is a safe approach for acute colonic volvulus.
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Affiliation(s)
- Eran Sadot
- Department of Surgery, Division of General Surgery, The Mount Sinai Medical Center, NY 10029, USA.
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Tsushimi T, Kurazumi H, Takemoto Y, Oka K, Inokuchi T, Seyama A, Morita T. Laparoscopic cecopexy for mobile cecum syndrome manifesting as cecal volvulus: Report of a case. Surg Today 2008; 38:359-62. [DOI: 10.1007/s00595-007-3620-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2006] [Accepted: 06/01/2007] [Indexed: 10/22/2022]
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12
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Augustin G, Majerovic M. Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol 2007; 131:4-12. [PMID: 16982130 DOI: 10.1016/j.ejogrb.2006.07.052] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Revised: 04/19/2006] [Accepted: 07/04/2006] [Indexed: 11/29/2022]
Abstract
Acute abdomen in pregnancy remains one of the most challenging diagnostic and therapeutic dilemmas today. The incidence of acute abdomen during pregnancy is 1 in 500-635 pregnancies. Despite advancements in medical technology, preoperative diagnosis of acute abdominal conditions is still inaccurate. Laboratory parameters are not specific and often altered as a physiologic consequence of pregnancy. Use of laparoscopic procedures as diagnostic tools makes diagnosis of such conditions earlier, more accurate, and safer. Appendicitis is the most common cause of the acute abdomen during pregnancy, occurring with a usual frequency of 1 in 500-2000 pregnancies, which amounts to 25% of operative indications for non-obstetric surgery during pregnancy. Surgical treatment is indicated in most cases, as in nonpregnant women. Laparoscopic procedures in the treatment of acute abdomen in pregnancy proved safe and accurate, and in selected groups of patients are becoming the procedures of choice with a perspective for the widening of such indications with more frequent use and subsequent optimal results. Despite these advances, laparotomy still remains the procedure of choice in complicated and uncertain cases.
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Affiliation(s)
- Goran Augustin
- Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia.
| | - Mate Majerovic
- Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia
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13
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Pirró N, Corroller LE, Solari C, Merad A, Sielezneff I, Sastre B, Champsaur P, Di Marino V. [Cecal volvulus: anatomical bases and physiopathology]. Morphologie 2006; 90:197-202. [PMID: 17432051 DOI: 10.1016/s1286-0115(06)74506-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
UNLABELLED The aim of this study was to report on 7 cases of cecal volvulus and to evaluate anatomical variations allowing this pathology. METHODS 7 consecutive patients (4 women) treated for cecal volvulus were included. The clinical and paraclinical parameters, the management of patients, were studied through an analysis of medical histories. Contributing factors for cecal volvulus were analysed by an anatomical study and literature analysis. RESULTS all patients complained about abdominal pain associating or not to acute intestinal obstruction. The diagnosis was radiographically carried out for 3 patients. All patients were treated by surgical procedures (right colectomy: n = 6, cecopexy: n = 1). The mortality and morbidity rates were 0 percent and 28 percent. Fifteen anatomical subjects had complete dorsal fixation (75 percent). Seven out of them had retrocecal recessus. Five subjects (25%) had a non fixed cecum, according to the literature relating a non-fixation of ascending colon to parietal peritoneum in 11 to 25 percent of the cases. The main factor of risk is the female gender. CONCLUSION cecal volvulus can be advocated for patients having abdominal pain. The diagnosis is rarely based on an only clinical examination or abdominal radiographs alone. Tomodensitometry is most performing examination for diagnosis. An early and appropriate management of patients is necessary to avoid significant morbidity and mortality rates.
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Affiliation(s)
- N Pirró
- Laboratoire d'Anatomie, Faculté de Médecine de Marseille, Secteur Timone, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05.
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14
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Abstract
Caecal volvulus is an infrequently encountered clinical condition and an uncommon cause of intestinal obstruction. Patients with this condition may present with highly variable clinical presentations ranging from intermittent, self limiting abdominal pain to acute abdominal pain associated with intestinal strangulation and sepsis. Lack of familiarity with this condition is a factor contributing to diagnostic and treatment delays. The objective of this review is to promote clinicians' awareness of this disease through patient case illustration, discussion of disease pathogenesis, clinical features, and management strategies.
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Affiliation(s)
- E T Consorti
- East Bay Surgery Program, University of California San Francisco, Oakland, California 94602-1018, USA
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Abita T, Lachachi F, Durand-Fontanier S, Maisonnette F, Roudaut PY, Valleix D, Descottes B. Les volvulus du cæcum. ACTA ACUST UNITED AC 2005; 142:220-4. [PMID: 16335894 DOI: 10.1016/s0021-7697(05)80907-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The cecum is the second most common site of colonic volvulus after the sigmoid. The mechanism is torsion or hyperflexion of the enlarged, poorly-fixed, and hypermobile cecum. It presents clinically as an acute bowel obstruction with strangulation. Diagnosis can be made by plain abdominal X-ray in more than half the cases on the basis of cecal distention (with a classical "teardrop" or "comma" appearance), proximal small bowel distention with air-fluid levels, and a gasless distal colon. Barium enema shows lack of filling of the cecum, often with a "beaked" termination of the column of contrast. CT images are pathognomonic when they reveal a cecal "vortex". After surgical reduction of the torsion, ileo-cecal resection is usually the best therapeutic alternative. Cecopexy may be aDDrouriate in older and debilitated Datients if there is no concomitant cecal necrosis.
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Affiliation(s)
- T Abita
- Service Chirurgie Viscérale et Transplantation, CHU Dupuytren, Limoges
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16
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Singla SL, Kadian YS, Goyal A, Sharma U, Kadian N. Caecal Volvulus in Pregnancy: Is Delay in Diagnosis Avoidable? Asian J Surg 2005; 28:52-4. [PMID: 15691800 DOI: 10.1016/s1015-9584(09)60260-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Intestinal volvulus is not an uncommon cause of obstruction in pregnancy. Diagnosis is often delayed due to poor knowledge of the condition and a hesitation to use abdominal X-rays in a pregnant patient. Here, two cases of caecal volvulus in pregnancy are reported. Proper diagnosis and early treatment of the condition is emphasized.
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Affiliation(s)
- Sham Lal Singla
- Department of General Surgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, 321 Housing Road, Rohtak 124001, Haryana, India.
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Konvolinka CW, Moore RA, Bajwa K. Cecal volvulus causing postoperative intestinal obstruction: report of a case. Dis Colon Rectum 2001; 44:893-5. [PMID: 11391155 DOI: 10.1007/bf02234716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cecal volvulus is a rare cause of intestinal obstruction after major abdominal surgery. A case of cecal volvulus occurring in the early postoperative period after left colon resection for malignancy is presented. Clinical evaluation and plain abdominal radiographs suggesting cecal volvulus prompted laparotomy and correction. Delay in diagnosis results in high mortality, and treatment depends largely on the viability of the involved intestine. This report describes the second case of cecal volvulus complicating a left colectomy. It was treated by detorsion and reperitonealization cecopexy.
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Affiliation(s)
- C W Konvolinka
- Department of Surgery, Conemaugh's Memorial Medical Center, an affiliate of Temple University, Johnstown, Pennsylvania 15905, USA
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John H, Gyr T, Giudici G, Martinoli S, Marx A. Cecal volvulus in pregnancy. Case report and review of literature. Arch Gynecol Obstet 1996; 258:161-4. [PMID: 8781706 DOI: 10.1007/s004040050119] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report a 23 year old woman at 24 weeks of gestation with known bulimia and gastritis who was admitted to the hospital with acute abdominal pain. Laparotomy confirmed the clinical diagnosis of cecal volvulus and a right hemicolectomy was performed.
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Affiliation(s)
- H John
- Department of Surgery, Ospedale Civico, Lugano, Switzerland
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20
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Wexner SD, Cohen SM. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 1995; 82:295-8. [PMID: 7795990 DOI: 10.1002/bjs.1800820305] [Citation(s) in RCA: 371] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Laparoscopic surgery is excellent for treating benign disease of the colon and rectum, and for palliative operations for malignancy. Its application for cure of colorectal malignancy, however, must be approached with caution. Port site recurrence of tumour is a particular, and increasingly recognized, drawback. This review discusses the evidence to date to support prospective randomized trials of laparoscopic colectomy for cure of carcinoma.
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Affiliation(s)
- S D Wexner
- Cleveland Clinic Florida, Department of Colorectal Surgery, Fort Lauderdale 33309-1743, USA
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Abstract
Laparoscopic surgical techniques have recently entered the field of colorectal surgery. Because the laparoscopic approach has revolutionized biliary surgery, it is hoped that similar advances will be possible in the more elderly population with colorectal disease. Early experience suggests that such advances have not been achieved and there is concern about developing minimal access surgical techniques in the face of potentially curable cancer. This article reviews the current state of knowledge based on published series; however, the current lack of controlled data in patients with extended follow-up makes this area highly controversial. Suggestions regarding the future of laparoscopic surgery are made and include the establishment of a national register and the development of controlled randomized trials.
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Affiliation(s)
- J R Monson
- University of Hull, Academic Surgical Unit, Castle Hill Hospital, Cottingham, North Humberside, UK
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