上行結腸軸捻転症の１例

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  • A CASE OF VOLVULUS OF ASCENDING COLON

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The patient was a 89-year-old female who visited her private physician on the following day of the appearance of abdominal pain and distention. Then she was referred to our hospital with diagnosis of ileus. An abdominal plain x-ray examination showed deviation of the pivot of the distended loop of colon to the right and some collection of gas in small intestine on the right side of the loop. CT of abdomen revealed extensive collection of gas in colon. Barium enema was performed with suspicion of lower colon obstruction, but no obstruction was found up to the level of sigmoid colon. With diagnosis of ileus in more proximal colon, emergency laparotomy was performed on the same day. On laparotomy it was found that the ascending colon was not fixed to retroperitonium and was rotated counterclockwise around transverse colon in 180 degrees. With diagnosis of volvulus of ascending colon, torsion was reduced and the ascending colon was fixed to retroperitoneum. The patient was readmitted 4 days after discharge due to occurrence of postoperative ileus and the presence of malrotation of intestine was suspected. Volvulus of ascending colon is rare and diagnosis can be reached by an abdominal plain x-ray examination most of the time.

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