Acute abdomen in a mentally retarded patient: cecal volvulus

Cecal volvulus is a rare emergency surgical condition caused by the torsion of the cecum, distal ileum, and the proximal colon around the axial plane related to the lack of normal fixation of the cecum [1]. Cecal volvulus’ clinical presentation varies a great deal, and while it can present with occasional abdominal pain it can also progress with severe abdominal pain. The severity of the pain depends on the level of cecal volvulus and the duration of intestinal obstruction [2]. It is quite hard to diagnose in the pre-operative period since it is very rare with no disease-specific symptoms [3]. The radiological method that is frequently used to confirm the diagnosis of cecal volvulus and to differentiate it from other acute emergency pathologies is computerised tomography (CT) [4, 5]. Successful treatment in patients depends on early diagnosis and timely intervention [1, 3]. The most effective treatment method is emergency resection of the segment with torsion around its mesentery in order to prevent progression to necrosis, which increases the risk of morbidity and mortality [2].
This study discusses the case of a mentally retarded patient with acute abdomen related to cecal volvulus in light of the literature on the subject.
The 50-year-old male patient presented to the emergency with complaints of severe abdominal pain, vomiting, and inability to discharge gas-stool that had been going on for a day. His medical history revealed that he had mental retardation. It was seen that he had hypoactive intestinal sound upon listening with occasional metallic sounds during his abdominal examination. There was distinctive distension, widespread sensitivity, and rebound. The patient’s biochemical parameters were within normal bounds and his white cell count was 16900/mm3. His standing direct abdominal graphy (X-ray) showed extremely dilated colon segments with blurred haustrations in the shape of a reverse U, and air-fluid levels in the right side of the abdomen (Figure 1). His CT results demonstrated distension in the colonic loops beginning with the cecal level and complete cycle rotation (whirlpool sign) of intestinal loops, mesentery, and vascular structures in the lower right quadrant (Figure 2). We postulated that his condition might have been related to cecal torsion.
Emergency laparotomy was planned taking the patient’s current physical examination, laboratory, and radiological results into consideration. The patient received...


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