Vólvulo de ciego. Presentación de un caso y revisión de la literatura

El vólvulo es la torsión anormal o rotación de una porción del intestino sobre su mesenterio, que ocasiona la oclusión de la luz, obstrucción y compromiso vascular. El vólvulo de ciego es una condición clínica poco frecuente y representa solamente entre el 2 y el 3 % de los casos de oclusión intestinal en el adulto. Se presenta el caso de una paciente, de 56, con antecedentes de padecer hipertensión arterial, diabetes mellitus y de constipación crónica, que acudió al cuerpo de guardia de cirugía del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos porque hacía varios días presentaba dolor abdominal intermitente, sensación de plenitud al comer y sin expulsión de heces, en ocasiones había tenido náuseas y vómitos escasos con restos de alimentos. Al examen físico se constató asimetría del abdomen a expensas del hemiabdomen derecho, que se encontraba doloroso, distendido y timpánico. La radiografía simple de abdomen informó imagen que semejaba un vólvulo de ciego. Se le realizó hemicolectomía derecha con una ileotransversostomia término-terminal en dos planos de sutura. En la actualidad la paciente lleva 6 meses de operada con evolución favorable. El diagnóstico de esta entidad se realiza durante la laparotomía en un gran número de casos, producto de sus múltiples formas de presentación que pueden ser desde un dolor abdominal agudo hasta llegar al choque séptico. Se presenta el caso por lo poco frecuente de esta entidad.

Volvulus is the abnormal torsion or rotation of a portion of the intestine on its mesentery, which causes occlusion of the lumen, obstruction, and vascular compromise. Cecum volvulus is a rare clinical condition and represents only between 2 and 3 % of cases of intestinal occlusion in adults. We present the case of a 56-year, female patient with a history of high blood pressure, diabetes mellitus and chronic constipation, who attended the surgery ward at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos because several days ago she had had intermittent abdominal pain, a feeling of fullness when eating and without expulsion of feces, on occasions she had had nausea and scarce vomiting with other food. The physical examination revealed abdominal asymmetry at the expense of the right hemiabdomen, which was painful, distended, and tympanic. The simple abdominal X-ray reported an image reminiscent of cecum volvulus. A right hemicolectomy was performed with an end-to-end ileotransversostomy in two suture planes. At present, the patient has been operated for 6 months with a favorable evolution. The diagnosis of this entity is made during laparotomy in a large number of cases, as a result of its multiple forms of presentation, which can range from acute abdominal pain to septic shock. The case is presented due to the infrequent nature of this entity.

Vólvulo de ciego desde dos variantes de tratamiento / Cecal Volvulus from two Treatment Variants

Introducción: El vólvulo de ciego es infrecuente en Occidente y representa solo el 1 por ciento de los casos de oclusión intestinal en el adulto. Los pacientes con esta entidad presentan habitualmente un cuadro clínico de dolor abdominal intermitente, vómitos, ausencia de expulsión de gases y heces por el recto. Objetivo: Describir dos alternativas de tratamiento ante el vólvulo de ciego. Presentación de caso: Se presentan dos casos de pacientes masculinos, ambos de la tercera edad que presentan cuadro clínico sugestivo de oclusión intestinal mecánica de intestino grueso por vólvulo de ciego. Se realizó laparotomía explorada con los diagnósticos antes referidos y se encontró vólvulo del ciego. Luego se aplicaron técnicas quirúrgicas distintas para cada caso según el estado individual de cada uno de ellos. Conclusiones: Fue factible la aplicación de técnicas quirúrgicas diferentes, tras valorar el estado individual de los pacientes, pues ambos presentaron una evolución favorable(AU)

Introduction: Cecal volvulus is uncommon in the West and represents only 1 percent of cases of intestinal occlusion in adults. Patients with this entity usually present a clinical picture of intermittent abdominal pain, vomiting, as well as absence of gas and stool expulsion through the rectum. Objective: To describe two treatment alternatives for cecal volvulus. Case presentation: The cases are presented of two cases of male patients, both elderly, with clinical symptoms suggestive of mechanical intestinal occlusion of the large intestine caused by cecal volvulus. Exploratory laparotomy was performed with the aforementioned diagnoses and cecal volvulus was found. Then different surgical techniques were applied for each case according to the individual condition of each case. Conclusions: It was feasible to apply different surgical techniques after assessing the individual condition of the patients, since both presented a favorable evolution(AU)

Obstrucción intestinal por vólvulo de ciego en paciente con malrotación intestinal asociado a situs ambiguous / Intestinal obstruction due to volvulus of the cecum in a patient with intestinal malrotation associated with situs ambiguous

Introducción. La oclusión intestinal, completa o incompleta, es uno de los cuadros de abdomen agudo más frecuentes. Constituye entre 20 % y 35 % de los ingresos urgentes en las áreas quirúrgicas hospitalarias. Caso clínico. Se presenta el caso de un paciente con antecedente de carcinoma de próstata, que consultó con un cuadro de obstrucción intestinal y abdomen agudo. Se le diagnosticó vólvulo de ciego, mal rotación intestinal y situs ambiguous. El tratamiento quirúrgico del paciente fue exitoso. Conclusión. El conocimiento de estas condiciones patológicas es imprescindible para poder brindarle un correcto tratamiento quirúrgico y disminuir la mortalidad que pueden acarrear

Introduction. Complete or incomplete intestinal obstruction is one of the most frequent acute abdomen conditions. It constitutes between 20% and 35% of the urgent admissions of hospital surgical areas. Clinical case. We present a case of a patient with a history of prostate carcinoma, who began with clinical symptoms of intestinal obstruction and acute abdomen. He was diagnosed with volvulus of the cecum, intestinal malrotation, and situs ambiguous. Surgical treatment of the patient was successful. Conclusion. Knowledge of these pathological conditions is essential to be able to provide correct surgical treatment and reduce the mortality that these can lead to

Respiratory distress and tracheal deviation secondary to sigmoid volvulus / Dificultad respiratoria y desviación traqueal secundaria a vólvulo sigmoideo ­ Un reporte de caso

INTRODUCTION: The trachea is a semiflexible tube of 1.5 to 2 cm in width and 10 to 13 cm in length. Its deviation might be caused by not only diverse thoracic but also abdominal pathologies, which may compromise the airway. We present a case of a severe tracheal deviation due to an abdominal pathology causing displacement of mediastinal structures. CLINICAL CASE: A 78-year-old woman presents with difficulty breathing. History of chronic bedridden and frequently constipated, last stool 5 days prior. On physical examination, cachectic complexion, dry mucous membranes, breathing superficially with scarce wheezing, SatO2 82% on room air. Abdomen distended with an absence of bowel sounds. Chest x-rays show severe tracheal deviation and abdominal x-ray with coffee bean sign. A laparotomy evidences a large sigmoid volvulus. A sigmoidectomy and descending colon colostomy is performed. Room air oxygen saturation improved after extubation to 96%.CONCLUSION: Desaturation and tracheal deviation were caused by a large sigmoid volvulus. Although these pathologies were thoracic, clinicians should suspect different underlying pathologies, in this case, abdominal

INTRODUCCIÓN: La tráquea es un tubo semiflexible de 1-5 a 2 cm de ancho y 10 a 13 cm de longitud. Puede presentar desviaciones en su trayecto, no solo por patologías torácicas, sino también abdominales, las cuales pueden comprometer la vía aérea. Presentamos el caso de una desviación severa de la tráquea por una patología abdominal que ocasionó desplazamiento de las estructuras mediastinales. REPORTE DE CASO: Mujer de 78 años que se presenta por dificultad respiratoria. Antecedente de postramiento crónico en cama y estreñimiento frecuente, con última deposición 5 días previos. En la exploración física presenta complexión caquéctica, mucosas secas, respiración superficial con sibilancias, saturando 82% al aire ambiente. Abdomen distendido con ausencia de ruidos intestinales. Radiografía torácica muestra desviación traqueal severa y la radiografía abdominal muestra signo del grano de café. En el abordaje por laparotomía se evidencia un vólvulo sigmoideo grande. Se realizó sigmoidectomía y colostomía del colon descendiente. La saturación al aire ambiente mejoró después de la extubación a 96%. CONCLUSIÓN: La desaturación y desviación traqueal fueron causadas por un vólvulo sigmoideo grande. Aunque estas patologías eran torácicas, el clínico debe sospechar diferentes patologías de base, como en este caso, abdominales.

Malrotación intestinal durante el embarazo: Causa de abdomen agudo oclusivo / Intestinal malrotation during pregnancy: Cause of acute occlusive abdomen

RESUMEN Fundamento: La malrotación intestinal en una embarazada es infrecuente. La incidencia de la oclusión es baja y los vólvulos son más frecuentes en el tercer trimestre de la gestación. La poca especificidad de los síntomas hace más complejo el diagnóstico temprano y el tratamiento oportuno. La asociación de estas enfermedades se considera potencialmente letal para la madre y el niño. Objetivo: Describir el caso de una paciente con oclusión intestinal por vólvulo de intestino delgado y malrotación en el curso del embarazo. Reporte de caso: Paciente de 23 años, primigesta, con 24.4 semanas de gestación, con dolores abdominales previos; se recibió en la Unidad de Cuidados Intensivos por sospecha de abdomen agudo en el embarazo. Luego de estudios imagenológicos y de laboratorio se decidió su intervención quirúrgica con el diagnóstico de obstrucción intestinal. El diagnóstico intraoperatorio fue vólvulo de intestino delgado y malrotación intestinal tipo I, se le practicó desvolvulación y operación de Ladd. La evolución fue favorable y se conservó la gestación. Conclusiones: La malrotación intestinal complicada con una oclusión en el curso del embarazo es rara y el retraso del diagnóstico puede tener implicaciones desfavorables en la evolución de la madre y su futuro hijo. Las dificultades para el diagnóstico de esta enfermedad es preocupación de la comunidad científica y debe sospecharse en gestantes que presenten síntomas y signos de oclusión intestinal y alteraciones en los estudios imagenológicos.

ABSTRACT Background: Intestinal malrotation in a pregnant woman is uncommon. The incidence of occlusion is low and volvulus are more frequent in the third trimester of pregnancy. The poor symptom specificity makes early diagnosis and treatment more complex prompt. The association of these diseases is considered potentially lethal for mother and child. Objective: To describe the case of a patient with intestinal occlusion due to intestinal volvulus thin and malrotation in the course of pregnancy. Case report: 23-year-old patient, primigravida, with 24.4 weeks of gestation, with previous abdominal pains; She was admitted to the Intensive Care Unit on suspicion of acute abdomen in pregnancy. After imaging and laboratory studies, it was decided her surgical intervention with the diagnosis of intestinal obstruction. The diagnosis intraoperative was small intestine volvulus and type I intestinal malrotation, she underwent devolvulation and operation of Ladd. The evolution was favorable and the pregnancy was preserved. Conclusions: Intestinal malrotation complicated by an occlusion in the course of Pregnancy is rare and delayed diagnosis may have unfavorable implications for the evolution of the mother and her future child. Difficulties in diagnosing this disease is a concern of the scientific community and should be suspected in pregnant women who present symptoms and signs of intestinal obstruction and alterations in imaging studies.

Unusual Case Report of Synchronous Caecal and Sigmoid Volvulus / Reporte de un caso inusual de presentación sincrónica de vólvulo cecal y de sigmoide

Abstract In the spectrum of patients with intestinal obstruction, volvulus is one of the least frequent etiologies (5-15 %). Synchronous volvulus of two colonic segments in a patient is regarded as rare, with few cases reported in the literature. The present report of synchronous cecal and sigmoid volvulus documents one of them: a patient who underwent subtotal colectomy and formation of ileostomy. Although the preoperative diagnosis of this entity is rare, it should be considered in these intraoperative findings for both intraoperative management, with resection and anastomosis or resection and stoma, and postoperative management. It has a significant impact on mortality if patients are treated with broad-spectrum antibiotic coverage, given the bacterial translocation and sepsis that they experience.

Resumen En el espectro de los pacientes con obstrucción intestinal, el vólvulo es una de las etiologías menos frecuentes, siendo esta del 5 % al 15 %. La presentación sincrónica de dos segmentos colónicos volvulados en el mismo paciente se considera una entidad rara, con pocos casos reportados en la literatura. El presente caso de vólvulo sincrónico del ciego y del sigmoide documenta uno de ellos, en un paciente que se llevó a colectomía subtotal con ileostomía. Aunque el diagnóstico preoperatorio de esta entidad es poco frecuente, se debe tener en cuenta a la hora de encontrarse estos hallazgos intraquirúrgicos para el manejo tanto intraoperatorio, con resección y anastomosis o resección y estoma, como posoperatorios, lo que tiene un impacto importante en la mortalidad, si se manejan los pacientes con cubrimiento antibiótico de amplio espectro, dada la translocación bacteriana y septicemias con los que cursan estos pacientes.

Elective laparoscopic sigmoidectomy with preservation of the superior rectal artery prior to endoscopic decompression in sigmoid volvulus

Sigmoid volvulus is a frequent cause of intestinal obstruction. Its management has evolved with the use of laparoscopic surgery, achieving an elective sigmoid resection with anastomosis after a flexible endoscopic detorsion. A female patient was admitted to the emergency room with abdominal pain, distention, and constipation. The abdominal computed tomography showed a whirled sigmoid mesentery in addition to dilated sigmoid loops, and coffee bean sign. The patient successfully underwent a flexible endoscopic detorsion and was scheduled for elective sigmoid colectomy with rectal superior artery preservation and primary anastomosis. During the sigmoid resection, the superior rectal artery preservation is related to a better prognostic, with less bleeding, anastomotic leakage, and hospital stay. Currently, there are few reports of the laparoscopic preservation of the superior rectal artery in patients with sigmoid volvulus. (AU)

Vólvulo de ciego / Cecal volvulus

RESUMEN El vólvulo de ciego involucra al colon derecho proximal, el ciego y el íleon terminal. Se necesitan dos requisitos, una fijación incompleta del ciego y la limitación del movimiento intestinal en un punto fijo que sirve como apoyo y eje para la rotación. Presentamos el caso de una mujer de 52 años que presentó una obstrucción intestinal aguda. Se hizo el diagnóstico preoperatorio con una tomografía y se realizó una colectomía derecha asistida por laparoscopía con anastomosis primaria. En estos pacientes se recomienda la colectomía derecha no oncológica ya que elimina por completo la posibilidad de recurrencia. No se recomienda la colonoscopía, la cecopexia, ni la cecostomía por su alto riesgo de recurrencia y morbimortalidad asociadas.

ABSTRACT Cecal volvulus involves the proximal right colon, the cecum and the terminal ileum. Two requirements are needed, an incomplete fixation of the cecum and the restriction of the bowel movement at a fixed point which serves as a fulcrum for rotation. We present a case of a 52-year-old woman who was admitted with the diagnosis of an acute intestinal obstruction. The preoperative diagnosis was made with a tomography and she underwent a laparoscopic assisted right colectomy with primary anastomosis. In these patients, the right colon nononcologic surgical resection is recommended because eliminates the possibility of volvulus recurrence. Colonoscopy, cecopexy, or cecostomy should be avoided because its associated significant recurrence, morbidity and mortality.

Multidisciplinary team working for diagnosis and treatment of fetal intestinal volvulus: report of two cases / 中华围产医学杂志

We report the diagnosis and treatment of two cases of fetal intestinal volvulus. Case 1 presented to Gansu Provincial Maternity and Child-care Hospital due to reduced fetal movements at 33 +4 weeks of gestation. Case 2 was referred to our hospital from a local hospital because of fetal bowel dilatation by ultrasound at 32 +5 weeks. Both cases were found to have fetal bowel dilatation with typical "whirlpool" or "coffee bean" signs on ultrasound after admission. After multidisciplinary consultation and discussion, an emergency cesarean section was performed, during which the two neonates underwent surgical operation and resection of necrotic bowel loops after confirming the diagnosis of volvulus and intestinal necrosis. Case 2 suffered from pulmonary artery thrombosis after the bowel surgery, and underwent pulmonary artery incision and embolectomy within 24 hours. Both newborns recovered well after the operation, whose growth parameters and nervous system development was normal for follow-up.

A deadly twist detorted / Philippine Journal of Obstetrics and Gynecology

@#Intestinal obstruction secondary to sigmoid colon volvulus in pregnancy is a rare but serious complication of pregnancy with significant maternal and fetal mortality. We report the first case in this institution of volvulus of the sigmoid colon in a pregnant patient on her 30th week age of gestation that was successfully managed conservatively with flexible colonoscopic decompression and detorsion. The presenting signs and symptoms seen in this patient are the same as with a nonpregnant patient and are often nonspecific. Hence, a high level of suspicion is essential for early diagnosis. Fetal and maternal mortality rates are higher during pregnancy if the diagnosis is delayed

Idiopathic ileal volvulus with multiple concomitant infections in a starving man

@#Background: Small bowel volvulus is defined as the torsion of the small intestine, potentially leading to bowel obstruction, gangrene and perforation. It is a rare condition, especially in adults. Case presentation: A 30-year-old man was retrieved from the jungle with severe weight loss and abdominal symptoms. He succumbed to death despite 22 days of intensive medical treatment. An autopsy revealed a ruptured gangrenous ileal volvulus with peritonitis and subdiaphragmatic abscess. Further laboratory analysis detected systemic Candida tropicalis and intestinal gramnegative bacterial sepsis, systemic Zika virus viremia, leptospirosis complicating rhabdomyolysis and disseminated intravascular coagulopathy, Type I Herpes Simplex virus infection of the tongue and upper gastrointestinal tract. The cause of death was the ruptured ileal volvulus, complicated with upper gastrointestinal bleeding due to Herpes simplex virus esophagitis in a malnourished patient with resolving leptospirosis and underlying Zika virus co-infection. Conclusion: Rare clinical scenarios of adult-onset intestinal volvulus with concomitant multiple infections precludes clinical diagnosis and early treatment, leading to devastating consequences of clinical outcome. The positive clinical and postmortem correlation is a good learning lesson in many disciplines of medicine and science.

A fatal twist in childhood: A post-mortem finding of intestinal volvulus with malrotation

@#Gastrointestinal pathology leading to the death in paediatric age group is uncommon. The diseases that encountered were mostly intestinal obstruction, peritonitis and gastrointestinal bleeding. Due to the severe symptoms, most of the patients presented to hospital in time and were treated appropriately. However, with the presence of contributing factors, certain gastrointestinal pathology can progress rapidly leading to the death. We report a rare case of intestinal volvulus in a 3 years old girl where the deceased presented with one day short history of vomiting before her demise. The contributing factors were bronchopneumonia sepsis and underlying intestinal malrotation identified via post-mortem examination.

Megadolicocolon de presentación poco usual en un paciente de edad avanzada: a propósito de un caso / Megadolicocolon with unusual presentation in an elderly patient: a case report

El megadolicocolon es una patología inusual, de etiología no bien esclarecida. Tal parece ser de origen congénito, se presenta con frecuencia en recién nacidos y lactantes con vólvulos de colon. Su incidencia es variable y se encuentra entre 1,9 y 28,5 %.Este reporte de caso es excepcional debido a que se presenta con una evolución y comportamiento agresivo de la enfermedad, pues se trata de un paciente de edad avanzada, con antecedente de sigmoidopexia y cuadro clínico de 7 meses de evolución consistente en estreñimiento crónico y exacerbación difusa de dolor abdominal incapacitante, quién requirió procedimiento quirúrgico de emergencia para su manejo

Megadolichocolon is an unusual pathology of not well clarified etiology. It seems to be of congenital origin and occurs frequently in newborns and infants with colon volvulus. Its incidence varies between 1.9% and 28.5%. This case report is exceptional because it presents with an aggressive evolution and behavior of the disease, since it is an elderly patient, with a history of sigmoidopexy and a clinical evolution of 7 months consisting of chronic constipation and diffuse exacerbation of disabling abdominal pain, who required an emergency surgical proce-dure for its management

Vólvulo del ciego, una entidad infrecuente como causa de abdomen agudo en embarazadas: reporte de caso clínico y revisión de la literatura / Volvulus of the cecum as an uncommon cause of acute abdomen in pregnant women: Case report and review of the literature

Introducción. El vólvulo cecal en el embarazo es una patología infrecuente a nivel mundial, con un espectro clínico variado y limitación en estudios diagnósticos, lo que puede resultar en un desenlace ominoso. Caso clínico. Se presenta el caso de una gestante en segundo trimestre del embarazo quien presenta abdomen agudo secundario a vólvulo cecal y sufrimiento fetal. La paciente fue llevada a cesárea de urgencia, donde además se practicó cecectomía y anastomosis íleo transversa, con mortalidad fetal. Discusión. El vólvulo cecal forma parte de los diagnósticos diferenciales en caso de abdomen agudo durante el embarazo. Tiene un pronóstico reservado, en donde pueden presentarse desenlaces maternos y perinatales adversos, con mortalidad materno fetal

Introduction. Cecal volvulus in pregnancy is an uncommon pathology worldwide, with a varied clinical spectrum and limitation in diagnostic studies, which can result in an ominous outcome.Clinical case. We present the case of a pregnant woman in the second trimester of pregnancy who presents with an acute abdomen secondary to caecal volvulus and fetal distress. The patient was taken to emergency caesarean section, where a cecectomy and transverse ileus anastomosis were also performed, with fetal mortality.Conclusion. Cecal volvulus is part of the differential diagnoses in acute abdomen during pregnancy. It has a reserved prognosis, where adverse maternal and perinatal outcomes can occur, including maternal-fetal mortality

Vólvulo ceco-ascendente / Ceco-ascending volvulus

El vólvulo ceco-ascendente es una presentación clínica poco frecuente y una causa de oclusión intestinal. Los pacientes presentan manifestaciones clínicas variables, desde dolor abdominal agudo hasta choque séptico. Se presenta el caso clínico de una paciente intervenida quirúrgicamente por un síndrome oclusivo, donde se comprobó un vólvulo ceco-ascendente con compromiso vascular. El vólvulo ceco-ascendente es una causa rara de obstrucción intestinal y debido a sus múltiples presentaciones clínicas, su diagnóstico en la mayoría de las ocasiones se realiza durante la laparotomía. El objetivo de este reporte es describir las características clínicas y tratamiento en pacientes con vólvulo ceco-ascendente.

Ceco-ascending volvulus is a rare clinical presentation and a cause of intestinal occlusion. Patients present variable clinical manifestations, from acute abdominal pain to septic shock. We present the clinical case of a patient undergoing surgery for an occlusive syndrome, where a ceco-ascending volvulus with vascular compromise was found. The caecal-ascending volvulus is a rare cause of intestinal obstruction and due to its multiple clinical presentations, its diagnosis in most cases is performed during laparotomy. The objective of this report is to describe the clinical characteristics and treatment in patients with ceco-ascending volvulus.

Prenatal ultrasound diagnosis of fetal intestinal volvulus and intussusception and misdiagnosis analysis / 中华超声影像学杂志

To investigate the characteristics of prenatal ultrasound sonography of fetal intestinal volvulus and intussusception , and analyze the misdiagnosis . Methods T he prenatal two‐dimensional and three‐dimensional sonographic features of 11 patients with volvulus and intussusception confirmed by prenatal ultrasound and/or postnatal confirmation from June 2017 to December 2018 were summarized and the prognosis were followed up . Results Of the 11 fetuses ,8 had intestinal volvulus and 3 had intussusception . Of the 8 cases of intestinal volvulus ,6 cases were correctly diagnosed by prenatal ultrasound ,and 2 cases were missed . Among the 6 cases diagnosed correctly ,3 cases showed a typical ＂vortex sign＂on the two‐dimensional sonogram . One case showed ＂coffee beans＂sign ,and 6 cases of three‐dimensional sonograms showed that the intestines were ＂coiled＂.＂Bread ring＂ sign appeared in 3 cases of intussusception ,and 1 case of intrauterine intestine was automatically reset . One of the 11 fetuses was induced to give birth ,1 was still in pregnancy ;9 cases were born and confirmed by surgery ,1 case died after operation . Conclusions Intestinal volvulus and intussusception have their characteristic sonographic features .When there is a short‐term fetal bowel dilatation with meconium peritonitis ,the existence of these two acute abdomen should be considered ,but w hen it is accompanied by intestinal necrosis ,typical signs of two‐dimensional sonograms are missing ,and three‐dimensional imaging aids in diagnosis .

Malrotación intestinal: a propósito de un caso / Intestinal malrotation: a case report

Existen múltiples patologías del abdomen que pueden ser diagnosticadas por parte del especialista en Diagnóstico por Imágenes; entre ellas, la malrotación intestinal es un hallazgo generalmente incidental. El médico imagenólogo debe ser capaz de reconocer los signos de la malrotación intestinal, al tratarse de una entidad patológica con complicaciones graves, como el vólvulo de intestinal. Para el diagnóstico, es clave su sospecha, así como las variantes de la normalidad que pueden conducir a un diagnóstico erróneo.

There are many diseases of the abdomen that can be diagnosed by the specialist in diagnostic imaging, including the intestinal malrotation is a finding usually incidental. The doctor specialist imaging must be able to recognize the signs of intestinal malrotation is a pathological entity, with serious complications, such as intestinal volvulus. For the diagnosis, it is the key to your suspicion, as well as the variants that can lead to a false diagnosis.

Vólvulo primario de íleon: una rara forma de obstrucción intestinal en el adulto: reporte de caso y revisión de la literatura / Primary volvulus of ileum: A rare form of intestinal obstruction in the adult: case report and literature review

Resumen Antecedentes El vólvulo de intestino delgado se produce por el giro anormal del intestino delgado alrededor del eje de su propio mesenterio, lo cual puede generar obstrucción intestinal, isquemia, infarto o perforación. Caso clínico Paciente masculino de 71 años que cursó con abdomen agudo. Sospechando cuadro de oclusión intestinal, se realizó exploración quirúrgica en la que se encontró como hallazgos vólvulo de intestino delgado en la válvula ileocecal, con isquemia y necrosis de 280 cm de intestino delgado, por lo cual se realizó resección intestinal e ileostomía terminal, preservando 320 cm de intestino delgado viable desde ángulo duodeno-yeyunal. Cursó con una evolución satisfactoria. Discusión El vólvulo de intestino delgado es una entidad infrecuente y una urgencia quirúrgica que amenaza la vida. Se debe sospechar en todos los pacientes que presenten dolor abdominal abrupto y signos de obstrucción intestinal, sin cirugía abdominal previa ni otras causas obvias. El diagnóstico precoz y la intervención quirúrgica inmediata son factores clave asociados con un mejor pronóstico para este grupo de pacientes.

Background The small bowel volvulus is caused by the abnormal rotation of the small intestine around the axis of its own mesentery. This can lead to intestinal obstruction, ischemia, infarction or perforation. Clinical case A 71-year-old male patient with an acute abdominal pain, suspicious for a bowel occlusion, performed a surgical exploration, finding small bowel volvulus at the ileocecal valve level, with necrosis and ischemia of 280 cm of the small intestine, resulting in intestinal resection and terminal ileostomy. Still preserving 320 cm of viable small intestine from the duodenojejunal angle, with a satisfactory evolution. Discussion Small bowel volvulus is an uncommon entity, and a life-threatening surgical emergency, that should be suspected in all patients with abrupt abdominal pain and signs of bowel obstruction, without previous abdominal surgery or other obvious causes. Early diagnosis and immediate surgical intervention are key factors associated with a better prognosis for this group of patients.

Transverse Colon Volvulus around the Gastrostomy Tube in a Pediatric Situs Inversus Patient

An 18-year-old male patient with cerebral palsy and scoliokyphosis came to the emergency department with abdominal distension and vomiting. He was a situs inversus patient with a feeding gastrostomy tube. Sigmoid volvulus was initially suspected, so rectal tube insertion and endoscopic decompression were attempted, but failed. So he went through explorative laparotomy, and transverse colonic adhesion and twisting around the gastrostomy tube and gastric wall was identified. Adhesiolysis and resection with redundant transverse colon and end-to-end colocolic anastomosis was performed. He discharged with symptom free. Suspecting transverse colonic volvulus is important when the patient has anatomical anomalies and feeding gastrostomy tube. Timely diagnosis with proper radiologic imaging should be made. Surgical resection of the redundant colon is needed for successful management of transverse colonic volvulus.

Vólvulo de colon transverso: a propósito de un caso / Transverse Colon Volvulus: a Case Report

El vólvulo de colon es la torcedura de un segmento del mismo sobre su mesenterio y es causa de obstrucción intestinal. El vólvulo de colon transverso es de presentación rara. Reportamos el caso de un varón de 55 años que inicia con distensión y dolor abdominal, ausencia de deposiciones y flatos, náuseas e hiporexia. Durante una laparotomía exploratoria, se halla un vólvulo que abarca el colon transverso hasta el ángulo esplénico y se le realiza resección de los mismos y una posterior anastomosis transverso-descendente. En conclusión, el presente caso clínico busca mostrar un caso raro de vólvulo colónico y a la vez enviar el mensaje de que el vólvulo colónico es una presentación de abdomen agudo quirúrgico que el personal médico debe saber reconocer clínicamente, debido a que su intervención inmediata evitará la isquemia y posterior necrosis del intestino grueso

A colon volvulus is the twisting of a colonic segment on its mesentery causing bowel obstruction. The transverse colon volvulus is an uncommon condition. We report the case of a 55-year-old male who initially showed bloating and abdominal pain, lack of bowel movements and flatus, nausea and hyporexia. During an exploratory laparotomy, a volvulus covering the transverse colon to the splenic flexure was found and resected with a posterior anastomosis of the transverse and descending colon. In conclusion, this clinical case report aims to show an uncommon case of colon volvulus and, at the same time, send the message that a colon volvulus is an acute (surgical) abdomen that medical personnel should know how to clinically recognize, because its immediate intervention will prevent the ischemia and subsequent necrosis of the large intestine