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A rare etiology of colonic occlusion: Cecal volvulus

Background. The cecal volvulus is an acute or chronic and recurrent cecum twisting. This is the second location after the sigmoid colon. This is a surgical emergency. Preoperative diagnosis is difficult and surgical treatment is controversial. We report our experience in the management of 2 cases of cecal volvulus in our Department in Dakar. Case Presentation. Case 1: A 38 years-old female patient, with no pathological individual history, was sent for an occlusive syndrome, lasting for 5 days. Abdominal examination revealed a symmetrical bloating, without defense or contracture. Blood cell count (BCC) objectified hyper leukocytosis at 11,900 / mm3 with neutrophil predominance (89%). An abdomen X-ray revealed small bowel and colic air-fluid levels. During clinic surveillance, the patient presented secondary fever to 38 °C and diffuse abdominal sensibility. Exploration by midline laparotomy objectified cecal volvulus in a clockwise spiral turn, with lesions of ischemia. She received cecal and 10 cm of terminal ileum resection with end-to- end ileocolic anastomosis. The postoperative course was uneventful. Case 2: A 40 years old male patient was received for an occlusive syndrome lasting for 3 days. Examination on admission had objectified a patient in fairly good condition, without fever. The abdomen was distended, with diffuse sensibility without defense or contracture. A blood cell count showed leucopenia with 4700 white cells/ mm3. Abdominal X-ray highlighted many small bowel type hydro-aeric levels. Rectal way enema was performed without improvement. The patient underwent laparotomy. In exploration, was objectified cecal volvulus with ileal involvement , the cecum was distended with ischemic lesions. We performed ileo - cecal resection. Restoration of continuity was done immediately by end-to-end ileocolic anastomosis. The postoperative course was uneventful. Conclusion : The cecal volvulus is a rare abdominal emergency. The surgical resection (ileocecal resection and right hemicolectomy ) gives the best immediate and long term results. Early diagnosis and prompt management before complications occurrence manage to reduce the mortality rate. Keywords: volvulus; cecum ; emergency resection

Auteur(s) : Konaté I, Toure AO, Charfi M, Ba PA, Ka I, Seck M, Cisse M, Toure CT
Année de publication : 2014
Type : Article
Mise en ligne par : SECK Mamadou