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Cecal Volvulus: Rare Presentation of Intestinal Obstruction-Case Report

Case Reports in Clinical Medicine 2021年第11期10卷 359-364页

作者： muhaned alhassan Hatem Al-Saadi Department of General Surgery Suhar Hospital Suhar City Oman

Introduction: Cecal volvulus is a rare cause of intestinal obstruction that occurs 1% - 1.5% of all intestinal obstructions. Causes of volvulus are usually unknown but it can be due to a defective peritoneal fixation of the ascending colon and cecum in 10% and secondary causes (surgical adhesions, colonic carcinoma or diverticulitis). Case Presentation: A 56-year-old woman presented with colicky abdominal pain, bilious vomiting and abdominal distention for two days, who has no history of previous surgery and no other gastrointestinal symptoms or chronic illness. On examinations, she looks ill, dehydrated, abdomen massively distended with exaggerated bowel sound but no signs of peritonitis. CT abdomen with contrast finding: type 11 cecal volvulus seen in midline to the left above the umbilicus reaching 8 cm with ileocecal junction as well as the elongated appendix is reaching the right iliac fossa. Emergency exploratory laparotomy was done and the finding was, obstructing rectosigmoid tumor with cecal volvulus. Discussion: Cecal volvulus is one of the rare causes of mechanical intestinal obstruction which required urgent surgical intervention, and it occurs due to an axial twist of the caecum, ascending colon and terminal ileum around the mesenteric pedicle. Conclusion: Radiological imaging helps in the diagnosis of cecal volvulus especially CT scan with contrast as gold standard for both diagnosis and assessment for complications. However, this should not delay the time of intervention especially if patient presented at late stage with evidence of peritonitis or bowel ischemia and surgical right hemicolectomy is the most effective treatment option. The colonic pathology always should be assessed, as it could be the primary cause of cecal volvulus.

关键词： Volvulus Intestinal Obstruction Colectomy Manual Detorsion Caecopexy Caecostomy

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Volvulus of Small Bowel Caused by GISTs: Case Report and Literature Review

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Case Reports in Clinical Medicine 2022年第5期11卷 200-205页

作者： muhaned alhassan Ayman Barghash Hatem Al-Saadi Department of General Surgery Sohar Hospital Sohar Oman Sohar Hospital Sohar Oman

Introduction: Gastrointestinal stromal tumors (GISTs) originating from the interstitial cells of Cajal and GISTs are the most frequent mesenchymal tumors in the gastrointestinal tract (20% to 30% occur in the small intestine). Most small-intestinal neoplasms are asymptomatic. The most common mode of presentation is partial small bowel obstruction, with associated symptoms of colicky abdominal pain, abdominal distention, nausea, and vomiting. Obstruction can be caused by luminal narrowing by the tumor itself or intussusception. Case Presentation: We presented an 85-year-old lady presented with acute intestinal obstruction and CT abdomen with contrast revealed, a large well defined solid mass lesion, enhanced in the arterial phase and inseparable from the jejunal loops and it measures 09 × 08 × 07 cm, likely GISTs with secondary volvulus of the small bowel. Emergency laparotomy with complete resection of the tumor and end-to-end anastomosis of jejunum was done. Discussion: Small-intestinal GISTs should be treated with segmental intestinal resection. If the diagnosis is known prior to resection, wide lymphadenectomy can be avoided as GISTs are rarely associated with lymph node metastases. GISTs are resistant to conventional chemotherapy agents. Imatinib (Gleevec) is a tyrosine kinase inhibitor with potent activity against the tyrosine kinase KIT and is used in those with metastatic disease and as an adjuvant chemotherapeutic agent.

关键词： GISTs Small Intestine MRI CT Scan Imatinib Tyrosine Kinase Inhibitor

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Expect the Unexpected: Bowel Obstruction Caused by <i>Taenia saginata</i>: A Case Report of Unusual Complications

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Case Reports in Clinical Medicine 2021年第7期10卷 191-196页

作者： muhaned alhassan Ayman Ibraheim Barghash Hatem Al-Saadi Department of General Surgery Suhar Hospital Oman

Background: Small bowel obstruction (SBO) is a common gastrointestinal condition often warranting acute surgical intervention. In human, tapeworm species can cause a parasitic infection by ingestion of raw or under cooked beef (T. saginata) or pork (T. solium and T. asiatica). Taeniasis usually presents with vague symptoms or mild abdominal pain and discomfort. The intestinal complications are not commonly mentioned in the literatures. Case presentation: We present 65-year-old Egyptian woman who lives in Oman, who is known to have type two diabetes mellitus and hypertension. She presented to Emergency department with abdominal pain and constipation for a period of three days. On examination, she was dehydrated with tachycardia (pulse rate: 110/minute) blood pressure of 100/60 mmHg and patient was afebrile. Abdominal examination revealed, mildly distended abdomen and tense, no guarding or rigidity no palpable mass, exaggerated bowel sound and rectum is empty on per rectal examination. Emergency laparotomy was performed with intra-operative findings of large foreign body impacted in the distal jejunum about 8 × 3 cm, cylinder in shape completely obliterating the lumen, distal loops was collapsed. Conclusion: Although Taeniasis is a very rare infection, index of suspicion such as a potential in the differential diagnosis as cause of an acute abdomen with unusual surgical complications should be considered. The diagnosis of these rare circumstances is usually made intraoperatively, and surgery is recommended only for the treatment of complications.

关键词： Tapeworm Cysticercus Taenia saginata Intestinal Obstruction Proglottids

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