Cecal volvulus
Introduction
Introduction to cecal torsion The cecal torsion refers to the torsion of the intestinal palsy in the ileocecal area, and the normal cecum adheres to the posterior abdominal wall without twisting. The cecal torsion is only secondary to the moving cecum. It is a rare cause of intestinal obstruction, which accounts for 1% of intestinal obstruction, as the cecum reverses the ileum and ascending colon in the vicinity. The cecal torsion is a closed intestinal obstruction, which can cause early intestinal blood circulation disorder, so the risk is high, and almost 100% of the acute torsion without surgery is dead. basic knowledge The proportion of sickness: 0.0022% Susceptible people: more common in young people under 40 years old Mode of infection: non-infectious Complications: peritonitis
Cause
Cause of cecal torsion
(1) Causes of the disease
The cecal torsion is caused by the moving cecum. The normal cecum is attached to the posterior abdominal wall and is completely covered by the peritoneum. There is no torsion. If the cecum is fixed and the mesangial is incomplete during embryonic development, the cecum and ascending colon are The membrane is too long and the activity is too large. This is the anatomical factor of cecal torsion. The causes of cecal torsion are excessive diet, diarrhea, excessive exertion and adhesion in the abdomen. Especially the abdominal surgery is often the direct cause of cecal torsion. Pelvic tumors, changes in the position of the cecum during pregnancy, or cecal dilatation caused by distal obstruction of the cecum, also make it easy to reverse.
(two) pathogenesis
The cecal torsion is often reversed with a portion of the distal ileum and ascending colon (Fig. 1). Clockwise torsion is common (85%), the degree of torsion is 360° or more, and the mesentery is also twisted to form a closed stenosis. Intestinal obstruction, long time can cause reversal of intestinal necrosis, the incidence of necrosis accounts for about 1/4, the end of the ileum obstruction after twisting, resulting in complete obstruction of the small intestine.
Partial cecal torsion is characterized by chronic incomplete intestinal obstruction, and the right lower abdomen can touch the cystic mass. After auto-reduction, the symptoms disappear, but it can be repeated.
In another case, the free cecum folds forward and upward, and the distal ileum and ascending colon are folded to form an obstruction. This cecal folding does not affect the mesangial blood vessels, so cecal necrosis does not occur, but some people think that cecal folding does not belong to cecal torsion. Because it does not meet the basic definition of volvulus (Figure 2).
Prevention
Cecal torsion prevention
1. Intestinal torsion is a strangulated intestinal obstruction. The torsion of the intestine can rapidly cause necrotic perforation and peritonitis. It is a dangerous and rapid development of intestinal obstruction. If it is not treated in time, the mortality rate is high. Therefore, once diagnosed, it should be treated in time, early surgical treatment. This not only can reduce intestinal tube resection and even avoid intestinal tube necrosis, which is of great significance for the rescue of patients' lives.
2, should strictly control the indications of non-surgical treatment, to avoid delays in surgery, resulting in adverse consequences.
3, cecal torsion treatment in time, most of the prognosis is good, such as intestinal stenosis, and even ruptured perforation has a poor prognosis. If the treatment is not timely or improper, the mortality rate is high. If the cecal torsion is not treated, the cause of the disease should be further examined. If necessary, elective surgery can be used to eliminate the cause of the disease to prevent recurrence.
Complication
Cecal torsion complications Complications peritonitis
In severe cases, the abdomen with asymmetrical bulge and irregular flatulence can be seen. If it cannot be reset in time, the flatulence and intestinal fistula may cause intestinal wall necrosis, perforation, peritonitis and even death due to intestinal narrowing. Peritonitis is a serious disease common to surgery caused by bacterial infections, chemical stimuli or injuries. Most of them are secondary peritonitis, which originates from abdominal organ infection, necrotic perforation and trauma.
Symptom
Symptoms of cecal torsion Common symptoms Abdominal tenderness, flatulence, bloating, abdominal distension, abdominal tenderness, bowel pain, abdominal pain, nausea, vomiting, constipation, intussusception, fecal vomit, fecal impaction
The cecal torsion is more common in young people under the age of 40, and there are many women. In normal times, due to the movement of the cecum, there may be chronic umbilical and right lower quadrant pain, abdominal flatulence and other symptoms. There are two types of clinical manifestations.
1. Acute cecal torsion suddenly severe pain in the right lower abdomen or mid-abdominal, which is the nature of colic, paroxysmal aggravation, and may have nausea, vomiting, anal stop defecation and other typical low intestinal obstruction performance, shock and poison may occur in the late stage of the disease Blood.
Physical examination: obvious abdominal distension, asymmetry of abdominal distension, tension in the right lower abdomen muscle, tenderness and rebound tenderness, faint swelling of the right lower abdomen can be reached, such as exudate in the abdominal cavity, tenderness can be spread throughout the abdomen, auscultation of bowel sounds or There is a sound of gas.
2. Subacute cecal torsion can be manifested as recurrent epilepsy of incomplete intestinal obstruction. Pain in the right lower quadrant is uncomfortable at the time of onset. There is a different degree of abdominal distension. The right lower abdomen can touch the cystic mass, there is tenderness, and the condition can last for several days. Symptoms are relieved after an automatic reset.
Examine
Cecal torsion examination
1. Plain film image of abdominal flat cecal torsion:
(1) significant expansion of the cecum: the dilated cecum can be located in any part of the abdomen, but it is common in the upper abdomen or the left upper abdomen. It has a liquid level. When the effusion is heavy, it is easily misdiagnosed as acute gastric dilatation. Identification, such as the expansion of the stomach after the suction, the image of the gas accumulation and effusion plane disappeared in the stomach, and the cecal torsion did not change.
(2) Signs of low intestinal obstruction: multiple liquid levels are arranged in a stepped manner.
(3) Terminal ileum, displacement: The terminal ileum can be filled with gas and can be abnormally located on the right side of the cecum, and the gas in the transverse colon and descending colon is relatively reduced.
2. Barium enema often shows that the expectorant is blocked in the colonic hepatic curvature.
Diagnosis
Diagnosis of cecal torsion
diagnosis
According to the history of low intestinal obstruction such as history and lower abdominal pain, and the development of clinical intestinal obstruction, right lower middle abdominal spasm and bulging cecal, the possibility of cecal torsion should be considered first. X-ray plain film shows significant expansion of the cecum. A gas-liquid level and an expectorant can be clearly diagnosed in the ascending colon.
Differential diagnosis
1. The clinical symptoms of cecal torsion of intestinal obstruction are not easy to distinguish from intestinal obstruction caused by other causes. The former has a rapid development of obstruction, and the right middle abdomen can be paralyzed and tender.
2. Gastric dilatation X-ray plain film on the airway plane of the cecum is similar to the gas-liquid level in the stomach. After taking out the gastric gas in the stomach tube and then observing it, it can be differentiated from gastric dilatation and gastric gas retention.
