Cecal volvulus: A rare post-partum complication

Mohamed Aymen Ferjaoui; Ramzi Arfaoui; Anis Haddad; Mohamed Amine Hannechi; Slim Khedhri; Khaled Neji

doi:10.1016/j.ijscr.2021.106461

Cecal volvulus: A rare post-partum complication

Int J Surg Case Rep. 2021 Oct:87:106461. doi: 10.1016/j.ijscr.2021.106461. Epub 2021 Sep 30.

Authors

Mohamed Aymen Ferjaoui¹, Ramzi Arfaoui², Anis Haddad³, Mohamed Amine Hannechi⁴, Slim Khedhri⁴, Khaled Neji⁴

Affiliations

¹ Department B of Gynecologic Surgery and Obstetric, Tunis Maternity Center, Tunis Medical School, El Manar Tunis University, Tunisia. Electronic address: mohamedaymen.ferjaoui@fmt.utm.tn.
² Maternity Department, Military Hospital of Tunis, Tunis Medical School, El Manar Tunis University, Tunisia.
³ Department of General and Digestive Surgery, La Rabta Teaching Hospital, Tunis Medical School, El Manar Tunis University, Tunisia.
⁴ Department B of Gynecologic Surgery and Obstetric, Tunis Maternity Center, Tunis Medical School, El Manar Tunis University, Tunisia.

Abstract

Introduction and importance: Cecal volvulus is a rare clinical condition. It is characterized by axial twist of caecum, terminal ileum and the ascendant right colon around their mesenteric pedicles. The main pathophysiologic mechanism is cecal hyper mobility associated to precipitating factor such as colonic tumor, abdominal mass or pregnancy. Cecal volvulus during pregnancy was reported, but it remains exceptional during postpartum period.

Clinical presentation: We report a case of cecal volvulus occurring in 37-year-old woman ten days after cesarean section delivery. She presented an acute abdominal pain associated to vomiting and nausea. X ray imaging and abdominal CT showed a large colonic obstruction, the caecum was dilated and located in the left hypochondrium. An open surgery was performed showing twisted bowels involving the caecum, the ileocecal junction and the right colon. There were necrotic areas on the colonic wall. Right hemicolectomy was performed with end to side ileo-colostomy. The evolution was marked by a serious septic shock causing patient's death.

Clinical discussion: Cecal volvulus is a rare condition. Its suggested mechanism associates cecal hyper mobility to a precipitating factor. Increased uterine volume may explain cecal volvulus during pregnancy. In post-partum period, it may be explained by rapid uterine size variation. Cecal volvulus diagnosis is challenging. In fact, its symptoms can be confused with post operative ileus after cesarean section delivery. Delayed management leads to worst prognosis.

Conclusion: Cecal volvulus during post-partum period is a rare condition, it may be serious in case of delayed diagnosis.

Keywords: Case report; Cecal volvulus; Cesarean section delivery; Postpartum period.