Ahmad Afaq, Najeeb Erum, Ul Haq Muhammad Burhan, Altaf Aatiqa, Moiz Abdul, Bashir Humaira, Uzair Muhammad, Inam Aatif
Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan.
Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan.
Int J Surg Case Rep. 2023 Nov;112:108904. doi: 10.1016/j.ijscr.2023.108904. Epub 2023 Oct 4.
A volvulus is a serious surgical emergency caused by torsion or hyper-flexion of the bowel loop and its mesentery on a fixed point. Cecal volvulus is an uncommon cause of intestinal obstruction, accounting for just 1-1.5 % of all cases of bowel obstruction.
A 33-year-old intellectually disabled male presented to the emergency department with complaints of generalized abdominal pain, absolute constipation, and non-projectile vomiting. He had a grossly distended and rigid abdomen with generalized tenderness and guarding. The abdomen was hyper-resonant. Bowel sounds were hypoactive. Digital rectal examination revealed an empty and collapsed rectum with no stool staining of the finger. Laboratory reports showed leukocytosis and neutrophilia. Radiographic imaging was consistent with acute intestinal obstruction. Laparotomy was performed, and cecal volvulus with viable bowel and acute appendicitis was diagnosed intra-operatively. Manual detorsion, cecopexy, and appendectomy were performed. The patient had an uneventful postoperative course. The patient is still on follow-up since June 2023, and no complication has occurred.
Cecal volvulus is an uncommon cause of intestinal obstruction with multiple etiologies. The annual incidence of cecal volvulus is estimated to be between 2.8 and 7.1 cases per million. Cecal volvulus may lead to life-threatening complications such as bowel ischemia and perforation.
Diagnosis of cecal volvulus must be made promptly to prevent bowel gangrene and perforation. In this case, manual detorsion and cecopexy were performed as the bowel was viable per-operatively due to early surgical intervention.
肠扭转是一种严重的外科急症，由肠袢及其系膜在固定点处扭转或过度弯曲引起。盲肠扭转是肠梗阻的罕见原因，仅占所有肠梗阻病例的1-1.5%。
一名33岁的智障男性因全身腹痛、完全便秘和非喷射性呕吐就诊于急诊科。他的腹部明显膨胀且僵硬，有广泛压痛和肌卫。腹部叩诊呈鼓音。肠鸣音减弱。直肠指检发现直肠空虚且塌陷，手指无粪便沾染。实验室报告显示白细胞增多和中性粒细胞增多。影像学检查结果与急性肠梗阻相符。进行了剖腹手术，术中诊断为盲肠扭转伴肠管存活及急性阑尾炎。进行了手法复位、盲肠固定术和阑尾切除术。患者术后恢复顺利。自2023年6月起该患者仍在随访中，未发生并发症。
盲肠扭转是肠梗阻的罕见原因，病因多样。盲肠扭转的年发病率估计为每百万人口2.8至7.1例。盲肠扭转可能导致危及生命的并发症，如肠缺血和穿孔。
必须及时诊断盲肠扭转以预防肠坏疽和穿孔。在本病例中，由于早期手术干预，术中肠管存活，因此进行了手法复位和盲肠固定术。
