Blind volvulus as uncommon location of intestinal obstruction

Abstract

Introduction: Blind volvulus causes approximately 1-3% of all causes of intestinal obstruction. In addition, it is the second most frequent localization of volvulus, preceded by that of Sigma, being more common in middle-aged women. The clinical picture is that of an intestinal obstruction, characterized by vomiting and abdominal distension. If signs ofsepsis (fever, tachycardia, or hypotension) and/or intestinal irritation appear. Intestinal ischemia should be suspected. For the diagnosis a simple Rx of abdomen should be requested as first test of image, observing the sign in ? grain of coffee ?. The treatment of choice is urgent surgery.

Objective: To describe a clinical case focused on blind volvulus as an uncommon location of intestinal obstruction.

Material and methods: Retrospective descriptive study, clinical case presentation.

Results: It describes the clinical case of a male patient of 80 years, with no history, comes from abdominal pain of 24 hours of evolution, in Mesogastrio, moderate intensity, colic type, accompanied by nausea that arrives to vomit for 20 times. Physical examination, normal vital signs. Distended Abdomen, absent hydroaerial noises, tenderness in right iliaca fossa. Laboratory, Leukocytes 14,700, neutrophils 85.2%. Simple abdominal X-ray, image in "Coffee Bean" in left hypochondria. Surgical intervention: Exploratory laparotomy, finding volvulus of blind with rotation of 360 degrees, necrosis and ischemia in cecum and ascending colon with two perforations at cecal level. After the evaluation of the patient, it was determined a diagnostic impression and its urgent surgical resolution, managing to avoid further complications. As initial diagnostic impression was suspected in volvulus of Sigma. The definitive diagnosis was carried out during the surgical procedure.

Conclusion: Blind Volvulus is an uncommon cause of intestinal obstruction. Initially the diagnosis is clinical, and the image test of choice is the simple X-ray of the abdomen. In addition, 10% is diagnosed during surgical exploration.