Pediatr Gastroenterol Hepatol Nutr.  2013 Jun;16(2):131-134.

A Case of Cecal Volvulus Presenting with Chronic Constipation in Lissencephaly

• Lee EK
• Kim JE
• Lee YY
• Kim S
• Choi KH

Abstract

Cecal volvulus is uncommon in pediatric patients and there are few reports of cecal volvulus with cerebral palsy. Here, we report the case of a 19-year-old male patient who presented with abdominal distension, a history of cerebral palsy, refractory epilepsy due to lissencephaly, and chronic constipation. An abdominal x-ray and computed tomography without contrast enhancement showed fixed dilated bowel intensity in the right lower abdomen. Despite decompression with gastric and rectal tube insertion, symptoms did not improve. The patient underwent an exploratory laparotomy that revealed cecal volvulus. Cecal volvulus usually occurs following intestinal malrotation or previous surgery. In this patient, however, intestinal distension accompanying mental disability and chronic constipation resulted in the development of cecal volvulus. We suggest that cecal and proximal large bowel volvulus should be considered in patients presenting with progressive abdominal distension combined with a history of neuro-developmental delay and constipation.

Keyword

Cecum; Inteseinal volvulus; Lissencephaly

MeSH Terms

Abdomen
Cecum
Cerebral Palsy
Constipation
Decompression
Epilepsy
Humans
Intestinal Volvulus
Laparotomy
Lissencephaly
Male

Figure

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  Fig. 1 (A) Initial abdominal plain x-ray showed dilated low intensity with gas formation in the gastric and large intestine region. (B) Supine abdominal plain x-ray revealed the fixed haustral gas formation despite the decompression with gastric and rectal tube insertion. (C) No contrast-enhanced abdominal computed tomography scan showed dilated bowel with air-fluid level in the right lower abdomen.

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  Fig. 2 After the laparotomy including cecal and ascending segmentectomy, intra-operative finding revealed cecal volvulus.

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