A Case of Right-sided Colonic Volvulus in a Cerebral Palsy Young Patient

Abstract

Right-sided colonic volvulus is rare, accounting for 0.4% of all colonic obstructions and 5.9% of all colonic volvulus. The patient was a 25-year-old woman. She had cerebral palsy and scoliosis due to severe neonatal asphyxia, and had undergone fundoplication, gastrostomy, and tracheostomy. She was brought into our hospital with a diagnosis of intestinal obstruction. A blood analysis revealed mild degree of inflammatory reaction. A CT scan showed a dilated colon in the right upper quadrant of abdomen, but the origin of the obstruction was unclear. On the second day of admission, the patient was operated on because of worsening abdominal distention after intestinal tract decompression. Intraoperative findings revealed that the right colon had not been fixed and the ascending colon, twisted 180 degrees, was invaginated into the right upper abdomen. Although there was no necrosis, serosal membrane damage and stasis were observed, and considering the risk of recurrence, the distended portion was resected and reconstructed with a functional end-to-end anastomosis. The postoperative course was good. When the disease affects a patient with cerebral palsy, it is sometimes difficult to make the preoperative diagnosis. However, we should determine whether or not torsion should be repaired within 24 hours after the onset and consider the risk of recurrence when resection of the intestine is considered.