Chapter 47: Colon and Rectum- Cecal Volvulus Flashcards

1
Q

What is it?

A

Twisting of the cecum upon itself and the mesentery

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2
Q

What is a cecal “bascule” volvulus?

A

Instead of the more common axial twist, the cecum folds upward (lies on the ascending colon)

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3
Q

What is the incidence?

A

≈25% of colonic volvulus (i.e., much less common than sigmoid volvulus)

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4
Q

What is the etiology?

A
  • Idiopathic
  • poor fixation of the right colon
  • many patients have history ofabdominal surgery
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5
Q

What are the signs/symptoms?

A
  • Acute onset of abdominal or colicky pain beginning in the RLQ and progressing to a constant pain
  • vomiting
  • obstipation
  • abdominal distention
  • and SBO
  • many patients will have had previous similar episodes
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6
Q

How is the diagnosis made?

A
  • Abdominal plain film
    • dilated, ovoid colon with large air/fluid level in the RLQ
      • often forming the classic “coffee bean” sign with the apex aiming toward the epigastrium or LUQ
  • (must rule out gastric dilation with NG aspiration)
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7
Q

What diagnostic studies should be performed?

A

Water-soluble contrast study (Gastrografin®), if diagnosis cannot be made by AXR, CT scan

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8
Q

What is the treatment?

A
  • Emergent surgery
  • right colectomy with primary anastomosis
  • or ileostomy and mucous fistula (primary anastomosis may be performed in stable patients)
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9
Q

What are the major differences in the EMERGENT management of cecal volvulus versus sigmoid?

A

Patients with cecal volvulus require surgical reduction, whereas the vast majority of patients with sigmoid volvulus undergo initial endoscopic reduction of the twist

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10
Q

Name the most likely diagnosis:

67-year-old male smoker on Coumadin®for chronic DVT notices LLQ pain after a strenuous coughing spell; LLQ mass detected on physical exam

A

Rectus sheath hematoma

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11
Q

What is the treatment?

60-year-old male with LLQ pain and “parrot’s beak” on x-ray c/w sigmoid volvulus

A

Proctosigmoidoscopy to decompress initially

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12
Q

78-year-old male with RLQ and “coffee bean” colonic dilation on x-ray c/w cecal volvulus

A

Ex lap with resection with primary anastomosis or ileostomy

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