Abstract
The patient was a 51-year-old male who presented with abdominal pain. Plain abdominal X-ray revealed free air, and a perforated peritonitis was diagnosed. Free air, marked dilatation of the small intestine and the colon, and a large amount of ascites were observed on abdominal computed tomography (CT). The vital signs taken on arrival indicated the presence of systemic inflammatory response syndrome (SIRS) (a heart rate of 180/min, respiratory rate of 36/min, and body temperature of 38.3°C). Therefore, emergency surgery was performed. During the operation, a pinhole perforation was observed in the duodenal bulb. Purulent ascites (1,500ml) was present, the cecum was distended and twisted 360 degrees clockwise. A cecal volvulus was diagnosed. Omental transposition, correction of the volvulus, and cecopexy were performed. The patient developed acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC) postoperatively. Intensive treatment was successful, and he was discharged on postoperative day (POD) 40.
A case of cecal volvulus complicated by perforated peritonitis is extremely rare. Multi-detector computed tomography is useful for making a preoperative diagnosis.
