Cecal volvulus with intestinal malrotation: a rare cause of bowel obstruction

Authors

  • Mohamed Hajri Department of General surgery,Mongi Slim University Hospital, Tunis, and Tunisia and Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
  • Ghofran Talbi Department of General surgery,Mongi Slim University Hospital, Tunis, and Tunisia and Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
  • Kais Abdel Moula Department of Radiology,Mongi Slim University Hospital, Tunis, Tunisia and Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
  • Rami Guizan Department of General surgery,Mongi Slim University Hospital, Tunis, and Tunisia and Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
  • Wael Ferjaoui Department of General surgery,Mongi Slim University Hospital, Tunis, and Tunisia and Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
  • Hafedh Mestiri Department of General surgery,Mongi Slim University Hospital, Tunis, and Tunisia and Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
  • Rached Bayar Department of General surgery,Mongi Slim University Hospital, Tunis, and Tunisia and Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
  • Leila Ben Farhat Department of Radiology,Mongi Slim University Hospital, Tunis, Tunisia and Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia

DOI:

https://doi.org/10.3329/bjms.v22i2.65010

Keywords:

Cecal volvulus, malrotation, bowel obstruction

Abstract

Introduction:Cecal volvulus is a rare cause of acute abdomen in adults. It accounts for less than 1% of intestinal obstructions and 25-30% of cases of colonic volvulus. Congenital intestinal malrotation is a complex disorder due to incomplete or faulty rotation and fixation of the gut during the fetal life.Cecal volvulus associated with intestinal malrotation is a very rare presentation. Over 16 cases were reported in the literature.

Case report:A 44-year-old man with no medical history, presented to the emergency department with a 2-day history of abdominal pain and bloating. On clinical examination, the abdomen was distended and tympanic to percussion, with diffuse abdominal tenderness. Abdominal X-ray (standing) showed a distended large intestine with an airfluid colonic level. CT scan showed a markedly dilated cecum measuring up to 14 cm, which were located in the left hypochondrium. A “whirl sign” and a superior mesenteric pedicle swirl were also noted. Emergency surgery was performed. Intraoperative exploration revealed a cecal volvulus with a largely distended hypermobile cecum located in the left hypochondrium, with preischemic signs within its wall. All the small gut was right-sided and the large gut left-sided, suggestive of mesenterium commune and intestinal malrotation. A right hemicolectomy withileo-transverse anastomosis was done. The postoperative course was uneventful. The patient is on regular follow up and is doing well.

Conclusion:We describe a rare case of surgical management of cecal volvulus associated with intestinal malrotation in a middle-aged patient with no medical history. This case highlights the importance of early diagnosis by physical examination and radiological findings to prevent serious complications. Emergent surgery was the key to this successful management and surgical resection could offer better results with lesser recurrence rate.

Bangladesh Journal of Medical Science Vol. 22 No. 02 April’23 Page : 445-448

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Published

2023-04-11

How to Cite

Hajri, M. ., Talbi, G., Moula, K. A., Guizan, R., Ferjaoui, W., Mestiri, H., Bayar, R., & Farhat, L. B. (2023). Cecal volvulus with intestinal malrotation: a rare cause of bowel obstruction. Bangladesh Journal of Medical Science, 22(2), 445–448. https://doi.org/10.3329/bjms.v22i2.65010

Issue

Vol. 22 No. 2 (2023)

Section

Case Reports

License

Copyright (c) 2023 Mohamed Hajri,GhofranTalbi, KaisAbdelmoula, Rami Guizani,WaelFerjaoui, Hafedh Mestiri, Rached Bayar, Leila Ben Farhat

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