Katoh Toshio, Shigemori Tsunehiko, Fukaya Ryo, Suzuki Hiroshi
Division of Surgery, Toyama Hospital, Tsu-City, Japan.
World J Gastroenterol. 2009 May 28;15(20):2547-9. doi: 10.3748/wjg.15.2547.
A 78-year-old woman presented with fever, severe abdominal pain, and distension. She had been institutionalized for depression and senile dementia. Laboratory examinations disclosed a leucocytosis (WBC: 12,500/microL) and elevated levels of serum C-reactive protein (2.8 mEq/L). Diagnosis of acute cecal volvulus was made from a "coffee bean sign" on an abdominal computed tomography and a "beak sign" on a gastrographin enema. An emergent laparotomy confirmed the diagnosis and an ileo-colectomy with primary anastomosis was carried out. The patient recovered after intensive respiratory care and fluid therapy, and then returned to her former institution. A review of Japanese literature disclosed that: (1) a marked increase of aged patients with mental disability presenting with cecal volvulus, (2) adoption of ileo-colectomy as the standard surgical procedure, and (3) improved survival of the patients, were observed in the last decade.
一名78岁女性因发热、严重腹痛和腹胀就诊。她因抑郁症和老年痴呆症而住院治疗。实验室检查显示白细胞增多（白细胞计数：12,500/微升），血清C反应蛋白水平升高（2.8毫当量/升）。通过腹部计算机断层扫描上的“咖啡豆征”和泛影葡胺灌肠造影上的“鸟嘴征”诊断为急性盲肠扭转。急诊剖腹手术证实了诊断，并进行了一期吻合的回肠结肠切除术。患者在强化呼吸护理和液体治疗后康复，随后返回她之前的机构。对日本文献的回顾显示：（1）在过去十年中，出现盲肠扭转的老年精神残疾患者显著增加；（2）采用回肠结肠切除术作为标准手术方式；（3）患者的生存率有所提高。
