P3071 - Cecal Volvulus Masquerading as Gastric Volvulus: A Rare Presentation of Intestinal Obstruction

Tulika Saggar, MD, Atul Sinha, MD, Sandra Gomez, MD, Jiten Desai, MD, Rucha Jiyani, MD, Saher Sheikh, MD, Deepthi Kagolanu, MD, Kevin Yeroushalmi, MD, Rajmohan Rammohan, MD, James Pellegrini, MD, Kaleem Rizvon, MD, Nausheer Khan, MD, Krishnaiyer Subramani, MD, Paul Mustacchia, MD, MBA
Nassau University Medical Center, East Meadow, NY

Introduction: A colonic volvulus occurs when a segment of the colon twists upon its mesentery and accounts for around 2% of all bowel obstructions in the United States. Elderly patients are the most commonly affected group, commonly presenting with abdominal distention, vomiting, constipation, and fluid-electrolyte imbalances. Imaging findings such as small intestinal air-fluid levels and/or distended colon play a pivotal role in diagnosis. However, clinical findings and diagnostic imaging are not always as expected, delaying appropriate management. We present a case that emphasizes that atypical clinical or diagnostic imaging findings can easily mask the presentation of cecal volvulus, delaying treatment and leading to fatal prognosis.

Case Description/Methods: 71-year-old female presented to the emergency room with complaints of sudden onset of right upper quadrant pain associated with emesis. Clinical examination demonstrated a distended abdomen with hypokinetic bowel sounds. CT scan of abdomen showed dilated structure containing oral contrast and air concerning for gastric volvulus. Emergent endoscopy showed dilated fundus and prominent mid gastric fold with volvulus and successful endoscopic detorsion. However, the patient still complained of intermittent abdominal pain. Repeat CT scan of abdomen showed cecal volvulus with dilated cecum located in the left upper quadrant. Surgery was consulted and exploratory laparotomy with right hemicolectomy was performed. No post procedural complications were noted and diet was advanced with eventual resumption of normal bowel movements.

Discussion: In this case report we want to emphasize that physicians should always include cecal volvulus as a differential diagnosis in elderly patients presenting with sudden abdominal obstruction. Classical signs and symptoms with supporting imaging studies can help diagnose cases in time, however, clinicians should keep in mind that cecal volvulus can present atypically. In this case, cecal volvulus was disguised as gastric volvulus. If clinical suspicion is high, patients should undergo surgical treatment as early as possible. If treatment is delayed, it carries a high mortality rate. Even after treatment, patients have high morbidity due to a prolonged ileus, wound infection, respiratory failure, and bowel obstruction. We hope this case raises awareness amongst physicians about how difficult it may be to diagnose a cecal volvulus and the increased need for suspicion in order to prevent poor outcomes.



Disclosures:


Tulika Saggar, MD, Atul Sinha, MD, Sandra Gomez, MD, Jiten Desai, MD, Rucha Jiyani, MD, Saher Sheikh, MD, Deepthi Kagolanu, MD, Kevin Yeroushalmi, MD, Rajmohan Rammohan, MD, James Pellegrini, MD, Kaleem Rizvon, MD, Nausheer Khan, MD, Krishnaiyer Subramani, MD, Paul Mustacchia, MD, MBA. P3071 - Cecal Volvulus Masquerading as Gastric Volvulus: A Rare Presentation of Intestinal Obstruction, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.