Cecal Volvulus Presenting as Epigastric Swelling and Mimicking Gastric Volvulus.


Caecal volvulus is the second most common volvulus involving the large bowel, following sigmoid volvulus. It usually manifests as closed-loop obstruction and patient usually presents with early gangrene and perforation. It is unusual for caecal volvulus to present as an epigastric swelling. We report a case of caecal volvulus in a 90-year-old patient who presented with an epigastric swelling.Case ReportA 90-year-old man presented to surgical emergency with complaints of progressive abdominal distension, obstipation and pain for 3 days; he had no associated comorbid conditions. On examination, the patient was dehydrated and had tachycardia. The supra-umbilical half of the abdomen was distended and associated with tenderness and guarding. X-rays findings were of multiple air fluid levels with a large air filled viscus occupying the upper abdomen (Figure 1).Computer tomography (CT) at the level of L2 also showed a large air filled viscus. On exploration, large bowel popped into the operative field as soon as the peritoneal cavity was opened (Figure 2).It included the cecum and ascending colon which were grossly distended, reaching upto 14 cm in diameter, rotated on the longitudinal axis clockwise and lying in the upper abdomen. There were signs of rupture of the tenia coli and impending perforation. The patient underwent derotation of the gut with right hemicolectomy and ileo-transverse anastomosis. Postoperative period was uneventful and patient was discharged in a stable condition and is healthy on follow up.

Discussion

The term volvulus is derived from the Latin word volvere (“to twist”.) Cecal volvulus is the second most common site of colonic volvulus after the sigmoid colon. It is regarded as a misnomer because, in most patients, the torsion is located in the ascending colon. Cecal volvulus is essentially a closed-loop obstruction that may lead to vascular compromise with consequent gangrene and perforation. It is a disease of the elderly, predominately affecting women.[1]

Cecal volvulus is responsible for 10%-15% of all cases of large-bowel obstruction; the most common site of large-bowel torsion being the sigmoid colon (80%), followed by the cecum (15%), the transverse colon (3%), and the splenic flexure (2%).[2] People with incomplete intestinal rotation generally have inadequate right colon fixation which is associated with clockwise torsion of the cecum, terminal ileum, and ascending colon. Based on autopsy reports, sufficient cecal mobility for volvulus and bascule formation is found in 11% and 25% of adults, respectively.[3] Prior abdominal surgery with colonic mobilization, recent surgical manipulation, adhesion formation, congenital bands, distal colonic obstruction, pregnancy, pelvic masses, extreme exertion, and hyperperistalsis have all been implicated as causative.[4]

The usual presentation is acute obstruction with progression to cecal gangrene and perforation. There is an associated distension of the abdomen, usually in the lower part. In contrast gastric volvulus presents as epigastric pain, upper abdominal distension and enderness. The diagnosis is based on the combination of clinical presentation, plain abdominal x-ray and barium enema. In gastric volvulus the Borchardt’s triad of pain, retching, and the inability to pass a nasogastric tube is diagnostic and reportedly occurs in 70% of cases.[6] This triad was absent in the present case. X-ray findings of cecal volvulus differ from gastric volvulus in its location being in the right lower abdomen rather than the epigastrium or the thorax.[7] CT is widely replacing barium contrast imaging as the preferred imaging modality for the diagnosis of volvulus. However in this case it was unable to identify the segment of bowel involved in the volvulus.

Early diagnosis is essential to reduce the substantial morbidity and mortality. The treatment is essentially surgical. Five surgical procedures have been used in the treatment of cecal volvulus: detorsion alone, cecopexy, cecostomy, both cecopexy and cecostomy, and resection. There are reports of decompression of cecal volvulus using a colonoscope or decompression tube and this modality of treatment can be given a chance.[8] The recurrence rate for detorsion alone was 13%, which is the same recurrence rate as for cecopexy.[9] Cecostomy had a recurrence rate of 1%, but there is a high incidence of wound infection, limiting the use of this procedure mainly in moribund patients. Resection eliminates the risk of recurrence entirely and is the procedure of choice in stable patients.

Key Points

  • Caecal volvulus is an uncommon cause of largebowel obstruction, which is commonly associated with gangrene and perforation.
  • A high degree to suspicion is required to diagnose this condition early.
  • Surgical management remains the treatment of choice in this condition.

References

  1. Rabinovici R, Simansky DA, Kaplan O, Kaplan O, Mavor E. Cecal volvulus. Dis Colon Rectum. 1990;33:765–69.
  2. Rogers RL, Harford FJ: Mobile cecum syndrome. Dis Colon Rect. 1984;27:399-402.
  3. Wolfer JA, Beaton LE, Anson BJ. Volvulus of the cecum. Anatomical factors in its etiology: report of case. Surg Gynecol Obstet. 1942;74:882-94.
  4. Margolin DA, Whitlow CB. The pathogenesis and etiology of colonic volvulus. Semin Colon Rectal Surg. 1999;10:129-138.
  5. Madiba TE, Thomson SR. The management of cecal volvulus. Dis Colon Rectum. 2002;45:264-67.
  6. Dibra A, Rulli F, Kaçi M, Çeliku E, Draçini X. Acute right intrathoracic gastric volvulus. A rare surgical emergency. Ann Ital Chir. 2013;84:205-07.
  7. Carter R, Brewer LA 3rd, Hinshaw DB. Acute gastric volvulus. A study of 25 cases. Am J Surg. Jul 1980;140(1):99-106.
  8. Janardhanan R, Bowman D, Brodmerkel GJ Jr, Agrawal RM, Gregory DH, Ashok PS. Cecal volvulus: decompression and detorsion with a colonoscopically placed drainage tube. Am J Gastroenterol. September 1987;82(9):912-14.
  9. Tejler G, Jiborn H. Volvulus of the cecum. Report of 26 cases and review of the literature. Dis Colon Rect. 1988;31:445-49.

‘Bottled mucus’ may help gut disease.


Bottled mucus may one day play a role in some gut diseases, according to US researchers.

A study of the slimy lining of the bowels, published in the journal Science, showed mucus had a role in calming the immune system.

_70126435_c0012364-duodenum_lining-spl

The team at Mount Sinai Hospital, in New York, believe it may be useful in diseases in which inflammation runs rampant in the intestines.

The human body naturally produces around a litre of mucus every day.

Researchers at the hospital and Mount Sinai School of Medicine were investigating why the lining of the bowel does not react to the trillions of bacteria which call the human intestines home. Elsewhere in the body, the immune system would launch a brutal attack against such invaders.

The team investigated the interaction between the mucus produced by the intestines and the immune system.

They showed that a mucus was not only acting as barrier between bacteria and immune system, but a component of the mucus was also calming the immune response. Sugars, or glycans, stuck to the a mucus protein called MUC2 were having the effect.

Lead researcher Dr Andrea Cerutti told the BBC: “We were able to show its ability to dampen the immune reaction in a specific type of immune cell, a dendritic cell, which orchestrates the immune response.

“But these are just initial studies; we know very, very little about mucus.”

Mucus treatments?

One area the team think mucus could help in is some bowel problems.

Crohn‘s disease, inflammatory bowel disease and ulcerative colitis are all poorly understood diseases, but do have inflammation, a part of the immune response, as a common feature.

Dr Cerutti said mucus was often disrupted in these patients and suggested that it may be possible to use mucus as a treatment.

One vision is to artificially synthesise mucus, although this is not currently possible, or a drug which can stimulate the same effect in the lining of the gut.

Whether such approaches to boost the mucus layer of the guts would help patients with bowel disorders is still unknown.

Mucus is not unique to the digestive system. It lines the lungs and streams out of the nose during a cold.

There is speculation that it could be producing similar immune-calming effects in the respiratory system and may be playing a role in allergies and asthma.

Dr Cerutti said even cancer may be affected by mucus: “Several aggressive tumours, such as colon, ovarian, and breast cancers produce mucus, including MUC2.

“Mucus produced by malignant cells may prevent protective immune responses against the malignant cells.”

Prof Jon Rhodes, from the department of gastroenterology at the University of Liverpool, said: “There’s a massive amount of work in this intriguing paper and it’s fascinating to read.

“To extrapolate this to just swallowing mucus would be hopelessly naive, but what might actually be interesting to speculate is that when the nature of the glycans are better understood it could lead to a very exciting and new type of therapeutic”

Source: BBC

Believe it or not, coffee enemas are very beneficial.


A conversation about enemas can stimulate everything from laughter to horror. There are many old wives tales about enemas and how they can “cure” everything from the common cold to cancer. So let’s took a look at the facts and science behind the use of enemas.

Ancient civilizations included enemas in their cleansing rituals. The pharaohs of Egypt had their ‘guardians of the anus,” a doctor who specialized in administering the enemas and keeping their bowels clean. In the 1700s, enemas were a common practice in France and were considered indispensable for vibrant health.

At the turn of the 20th century, scientists in Germany noticed that caffeine opened the bile ducts and stimulated the production of bile in the liver of laboratory animals. Coffee enemas were even included in the Merck Manual, which is the medical doctor’s “bible,” until 1972.

Coffee enemas have gained modern popularity because of natural cancer protocols such as the Gerson Therapy, which incorporates daily enemas as part of their healing regime.

What exactly is an enema? An enema involves the insertion of a small tube into the rectum and then introducing fluids like coffee or herbal teas into the large intestine. This is best accomplished while lying on the left side with knees slightly bent. The amount of fluid can vary from one to four quarts, depending on what the need may be. Retaining the enema for 15-20 minutes provides the best results.

The benefits of the coffee enema are primarily due to the detoxification of the liver and not necessarily the emptying of the lower bowel. With the barrage of chemicals we are exposed to every day, as well as the internal toxins that are produced from daily metabolism, the liver can become overloaded and burdened with an excessive amount of toxicity.

As the coffee sits in the bowel, the fluid is absorbed through the intestinal wall into the blood stream, specifically through the portal vein of the liver. This carries the stimulating effects of the caffeine and other phytochemicals into the back door of the liver, so to speak, and stimulates the liver and gall bladder. Since fresh blood flows through the liver every three minutes, the detoxification of the liver is quite significant during those 15-20 minutes.

Aside from the detoxification of the liver, the coffee enemas provide certain phytochemicals, specifically kahweol and cafestol. These nutrients activate glutathione, which is a primary antioxidant in the cell. Detoxification on a cellular level is key to healing and creating vibrant health.

In laboratory studies, Kahweol has shown anti-inflammatory properties, stopped formation of new vascularity or blood flow in the early formation of tumors.

Both kahweol and cafestol have displayed anti-cancer properties in laboratory studies.

Enemas can also be performed with various teas, such as green tea or red clover tea, although coffee is said to produce better results.

If you are on a specific healing journey or you simply want to detox, make coffee enemas a regular part of your wellness protocol.

Sources:

http://www.ralphmoss.com/coff.html
http://en.wikipedia.org/wiki/Coffee_enema
http://www.annieappleseedproject.org/hisandsomsci.html
http://www.ncbi.nlm.nih.gov/pubmed/21858104
National Toxicology Program Cafestol (CASRN 469-83-0) and Kahweol (CASRN 6894-43-5) – Review of Toxicological Literature. (PDF)
http://en.wikipedia.org/wiki/Liver

About the author:
Dr. Veronique Desaulniers, better known as Dr. V, has maintained successful practices in the Wellness Industry since 1979.
Specializing in Bio-Energetics, Meridian Stress Analysis, Homeopathy, Thermography and Chiropractic, Dr. V brings a unique approach to Health and Wellness.
After personally overcoming Breast Cancer without the use of chemo, radiation or surgery, Dr. V currently helps to empower women about healing and preventing Breast Cancer, naturally.
For more information about Dr. V’s personal Cancer Coaching visit http://www.BreastCancerConqueror.com
Learn more: http://www.naturalnews.com/036763_coffee_enemas_detoxification_natural_cures.html#ixzz23FwIbRHA