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  • Title: Synchronous volvulus of the cecum and sigmoid colon: a rare cause of intestinal obstruction.
    Author: García-Granados AR, Castañeda-Martínez LE.
    Journal: Cir Cir; 2021; 89(S2):4-8. PubMed ID: 34932538.
    Abstract:
    A 102-year-old female with a past medical history of sigmoid volvulus resolved by colonoscopy a year ago presents to the emergency department with sigmoid volvulus, which is resolved by colonoscopy and rectal tube placement. Three days later, she presented abdominal distention and recurrence of the volvulus, for which a surgical resolution was decided. Laparotomy was performed, where sigmoid and cecal volvulus was found. A cecal detorsion and a cecopexy were performed, and an extended left hemicolectomy with a terminal colostomy to treat the sigmoid volvulus. The patient presents an adequate postoperative period and is discharged. Three months later, the patient was in good clinical condition, eating normally without complications. Volvulus refers to the torsion of a segment of the gastrointestinal tract. The most common sites for colonic volvulus are sigmoid and cecum; however, it is infrequent for these to occur together. We only found six cases reported in the literature of synchronous volvulus of the cecum and sigmoid colon. None of the cases was the diagnosis made preoperatively, suggesting a difficult diagnosis. Treatment depends on the patient's condition; in most reported cases, a subtotal colectomy was performed. The prognosis depends on prompt surgical intervention. Se reporta un caso de una femenina de 102 años de edad, con antecedente de vólvulo sigmoideo resuelto por medio de colonoscopia hace un año. Se presenta al servicio de urgencias con vólvulo sigmoideo, el cual se resuelve por medio de colonoscopia y se coloca un tubo rectal. Tres días después, presenta nuevamente distensión y recurrencia del vólvulo, por lo cual se decide resolución quirúrgica. Durante la cirugía se encuentra un vólvulo sigmoideo, así como cecal. Se realiza una detorsión con cecopexia y hemicolectomía izquierda con colostomía terminal. La paciente presenta adecuada evolución. Sin complicaciones tres meses después. Vólvulo se refiere a la torsión de un segmento del tracto gastrointestinal. Los sitios más comunes de vólvulos colónicos son sigmoides y ciego, sin embargo, es extremadamente raro que estos se presenten juntos. Únicamente encontramos seis casos reportados en la literatura de vólvulo sincronico sigmoideo y cecal. En ninguno de los casos, se hizo el diagnóstico preoperatoriamente, lo que sugiere un diagnóstico complicado. El tratamiento depende del estado del paciente; en la mayoría de los casos reportados, se realizó una colectomía subtotal. El pronóstico depende de la intervención quirúrgica oportuna.
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