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Case 89

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A 52-year-old previously healthy male patient sought for medical assistance due to a colicky abdominal pain which had begun about 18 hours before and had since worsened. He had not passed stool or flatus for more than 24 hours. On physical examination, he presented with diffuse abdominal distension and tenderness. He also presented with a tympanic percussion note in the left lumbar and hypochondriac regions. His pain seemed more intense in the lower abdomen. An anteroposterior abdominal radiography was carried out with the patient lying in a supine position.

Based on the clinical history and image provided herein, the most likely diagnosis is:

a) Giant colonic diverticulum

25%

b) Sigmoid volvulus

25%

c) Cecal volvulus

25%

d) Colorectal tumor

25%
   

Comments

- A volvulus is the complete twisting of a hollow viscus on itself and might involve any part of the gastrointestinal tract. The sigmoid colon and cecum are the most frequently affected sites.

- In Brazil, the chagasic megacolon is an important predisposing factor.

- Aged, debilitated and institutionalized patients are more prone to volvulus.

- Endoscopic decompression might be attempted as an initial therapy.

- The Hartmann’s procedure is indicated for patients who develop bowel necrosis or in those who failed to respond to nonsurgical therapy.

References

- Almeida, MWR et al . Síndrome de Chilaiditi associada a volvo de cólon sigmóide: relato de caso. Rev bras. colo-proctol., Rio de Janeiro, v. 26, n. 4, Dec. 2006 .

- Atamanalp SS, Yildirgan MI, BaÅŸoÄŸlu M, et al. Sigmoid colon volvulus in children: review of 19 cases. Pediatr Surg Int 2004; 20:492.

- Batista, TPaulo et al . Volvo de ceco complicado por icterícia séptica. Rev. Col. Bras. Cir., Rio de Janeiro, v. 37, n. 6, Dec. 2010 .

- Hodin, RA. Sigmoid volvulus. UpToDate. Available at: http://www.uptodate.com/contents/sigmoid-volvulus

- Maya, AM et al. Vólvulo del colon sigmoide: Signo del grano de café. Medicina (B. Aires) [online]. 2010, vol.70, n.4, pp. 371-371.

Author

Fernanda de Souza Foureaux, 5th year medical student of UFMG School of Medicine. Email: fernandasfx[at]hotmail.com

Supervisor

Dr. Guilherme Brasil Jurdi - General surgeon at Hospital Risoleta Tolentino Neves, in Belo Horizonte

Email: gbjurdi[at]hotmail.com

Reviewers

Professor Viviane Parisotto, Júlio Guerra e Fabiana Resende.

Translated by

Lucas Resende Lucinda, 5th year medical student of UFMG School of Medicine

Commentics

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