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老年女性盲肠扭转:肠梗阻的罕见病因

Cecal Volvulus in an Elderly Woman: A Rare Cause of Bowel Obstruction.

作者信息

Branco Tiago, Ávila Leonor, Rodrigues Ana, Ferreira Ágata

机构信息

General Surgery, Centro Hospitalar do Oeste, Caldas da Rainha, PRT.

General Surgery, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisboa, PRT.

出版信息

Cureus. 2024 Feb 4;16(2):e53571. doi: 10.7759/cureus.53571. eCollection 2024 Feb.

Abstract

Cecal volvulus is a rare, life-threatening form of bowel obstruction caused by the entanglement of the bowel around the mesenteric axis, compromising blood supply and leading to obstruction and ischemia. The diagnosis is challenging due to its highly variable clinical presentation and differential diagnoses, which may delay timely intervention. This is a case report of an 89-year-old woman who presented with a two-day history of lower right quadrant abdominal pain, nausea, and a temporary loss of consciousness. She also reported a history of chronic constipation. Clinical examination and imaging were suggestive of bowel obstruction, prompting further investigation. Plain radiography and abdominal CT confirmed bowel obstruction, with suspicion of volvulus. The diagnostic uncertainty between cecal and sigmoid volvulus prompted a colonoscopy, which excluded sigmoid volvulus. Emergency laparotomy revealed cecal volvulus and a distended cecum with ischemic changes but without necrosis. A right hemicolectomy was performed, and the patient recovered well postoperatively. This case report aims to expand the medical knowledge around the topic of cecal volvulus. It underscores the challenges in diagnosing and managing this condition and emphasizes the importance of prompt recognition and surgical intervention to improve patient outcomes.

摘要

盲肠扭转是一种罕见的、危及生命的肠梗阻形式,由肠管围绕肠系膜轴缠绕引起,会损害血液供应,导致梗阻和缺血。由于其临床表现高度多变且鉴别诊断困难,诊断具有挑战性,这可能会延误及时干预。本文报告了一名89岁女性患者,她有右下象限腹痛、恶心和短暂意识丧失两天的病史。她还报告有慢性便秘史。临床检查和影像学检查提示肠梗阻,促使进一步检查。腹部平片和CT证实肠梗阻,怀疑有肠扭转。盲肠扭转和乙状结肠扭转之间的诊断不确定性促使进行结肠镜检查,排除了乙状结肠扭转。急诊剖腹探查发现盲肠扭转和扩张的盲肠伴有缺血改变,但无坏死。进行了右半结肠切除术,患者术后恢复良好。本病例报告旨在扩展关于盲肠扭转主题的医学知识。它强调了诊断和管理这种疾病的挑战,并强调了及时识别和手术干预对改善患者预后的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e1e/10914306/2a911163a9a1/cureus-0016-00000053571-i01.jpg

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