Caecopexy as management for caecal volvulus: An evidence-based case report

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.

Mobile caecum as a content in recurrent incisional hernia an incidental finding: A rare case report

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Mobile caecum as a content of hernial sac in recurrent incisional hernia is a very rare entity.

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As per the available literature this is the first case of mobile caecum as content of recurrent incisional hernial.

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Caecopexy using the lateral peritoneal flap is the treatment of choice for mobile caecum.

Introduction

Recurrence in ventral hernia after laparoscopic repair is less as compared to conventional approach. Mobile caecum as a content of ventral hernia is a very rare entity. Standard treatment for mobile cecum is caecopexy using lateral peritoneal flap.

Case report

A 40-year-old obese female, homemaker by occupation with a history of incisional hernia 2 year back and treated with intraperitoneal on lay mesh repair presented with swelling in the left lower abdomen for past 6 months. Radiological investigations revealed defect in left lower anterior abdominal wall with protruding bowel loops. Urgent exploratory Laparotomy revealed mobile segment of ileocecal junction in the hernial sac cavity. Caecopexy for the mobile caecum was done.

Discussion

Mobile caecum is due to embryological failure of fusion of right colonic mesentery with lateral peritoneal wall. Pre-operative diagnosis of mobile caecum is difficult to establish unless it presents as caecal volvulus Caecopexy using the lateral peritoneal flap is the standard of care.

Conclusion

Mobile caecum can surprise the attending surgeon as a content of ventral hernia. Caecopexy using lateral peritoneal flap is the treatment of choice in all with a mobile caecum.

Acute cecal volvulus: A diagnostic and therapeutic challenge in emergency: A case report

Introduction

Cecal volvulus is an uncommon cause of intestinal obstruction due to an axial twist of the caecum, ascending colon and terminal ileum around the mesenteric pedicle. It is responsible for 1%-1.5 of all intestinal obstructions in adult. The clinical signs may be highly variables and can be responsible of delays in diagnostic and treatment. The delay in diagnosis leads to intestinal necrosis or perforation. The mortality ranges from 10 to 40% depending on the presence of a viable or gangrenous intestine.

Presentation of case

A 64 year old woman admitted the emergency department for acute bowel obstruction. Clinical examination found typically acute bowel obstruction signs. Plain radiography showed dilated gas-filled segment of the colon in the left side of abdomen and volvulus of cecum was suspected. Enhanced abdominal CT scan confirmed the diagnosis. Emergency exploratory laparotomy was performed and confirmed the cecal volvulus. A manual untwisting of volvulus and a Caecopexy were performed. The patient subsequently recovered uneventfully and was discharged on postoperative day 3.

Discussion

The management of cecal volvulus requires prompt (emergency) diagnosis and prompt surgical intervention. Any delay in diagnosis may lead to intestinal necrosis or perforation and worsening the prognosis in patients who are generally elderly. Several authors reported a high mortality rate of cecal volvulus due to delay to diagnosis and surgical intervention.

Conclusion

The low incidence of this condition needs a high index of suspicion and emergency surgical management. Despite significant progress in medical imaging, the preoperative diagnosis of cecal volvulus is very difficult. As a result, the treatment is often delayed.

Percutaneous Antegrade Colonic Stent Insertion Using a Proximal Trans-peritoneal Colopexy Technique

INTRODUCTION

Conventionally, colonic stents are inserted with a retrograde trans-anal approach-however, stenting of right-sided or proximal transverse colon lesions may pose a challenge due to tortuosity or long distances. We report three successful cases of percutaneous antegrade colonic stenting in patients using a proximal trans-peritoneal colopexy technique.

MATERIALS AND METHODS

Three patients underwent a proximal trans-peritoneal colopexy technique for antegrade colonic stent placement. The patients included three males, ages 89, 92 and 55, who were unsuitable for conventional methods. All patients had a colopexy with the aid of three gastropexy sutures performed under CT or fluoroscopic guidance and subsequent colonic access, followed by the crossing lesion and subsequent deployment of an uncovered colonic stent. A 10-Fr pigtail catheter was exchanged for the sheath, capped and left in place along with the colopexy suture anchors.

RESULTS

Percutaneous antegrade colonic stent placement was technically successful in all patients with no complications. Follow-up at 10 days, a tubogram confirmed stent patency. The pigtail drain and suture anchors were subsequently removed.

CONCLUSION

Antegrade colonic stenting with the use of a three point colopexy is a straightforward well-tolerated procedure and is a useful technique in a cohort of patients in whom conventional stenting has failed/is unsuitable. Additionally, we believe we have reported the first two cases involving transverse colon access for stenting.

Laparoscopic management of foramen of Winslow incarcerated hernia

Foramen of Winslow hernia (FWH) is a rare and often overlooked diagnosis with a high mortality rate. Widespread availability of cross-sectional imaging allows early diagnosis and prompt management. In this setting, before ischemia occurs, explorative laparoscopy would be the most suitable approach. Experience, however, remains sparse, and technical difficulties may be encountered. This is the case of a 38-year-old Caucasian woman who presented to the emergency department for a sudden epigastric pain. Physical exam was unremarkable, and routine blood tests were within normal range. An abdominal computed tomography (CT) scan confirmed the diagnosis of ileocaecal herniation through the foramen of Winslow. Under urgent laparoscopy, the caecum appeared viable but incarcerated in the lesser sac. Caecal puncture was the key to achieving atraumatic reduction of the hernia and bowel salvage.