2019 Volume 55 Issue 2 Pages 264-268
We report a case of cecal volvulus that was diagnosed laparoscopically in an otherwise healthy 13-year-old girl. Her chief complaint was sudden abdominal pain. She had no previous history of illness. Abdominal X-ray failed to detect any sign of bowel obstruction, but abdominal computed tomography (CT) clearly showed a “whirlpool sign” of twisted mesenteric vessels, raising the suspicion of bowel torsion. As the pain failed to improve, we began staging laparoscopy 12 hours after the onset of pain. The cecum was twisted 270 degrees, and required a twist detorsion before starting the laparoscopic cecopexy. The postoperative course was good, and the patient was discharged on postoperative day 7. Diagnosing cecal volvulus before an emergency operation based on X-ray or CT findings is difficult. If the diagnosis of cecal volvulus can be made earlier, signs of bowel obstruction are likely to be less clear. The “beak sign” is useful for diagnosis by bowel contrast radiography, but the contrast agent used in imaging may cause perforation. In the present case, abdominal pain and the “whirlpool sign” on CT led to the suspicion of cecal volvulus and demonstrated the utility of staging laparoscopy for early diagnosis, which together with timely surgical intervention, is crucial to saving the ileocecum.
