A case of cecal volvulus mimicking Ogilvie Syndrome in a hospitalized patient with a pelvis fracture

INTRODUCTION Cecal volvulus and ogilvie syndrome are two entities which may display similar clinical presentation but require different treatment approaches. PRESENTATION OF CASE An 84-year old male patient admitted for conservative treatment of a pelvis fracture, complained of abdominal cramps and flatulence on the third hospitalization day. Abdominal radiographs arose suspicion of cecal volvulus. The diagnosis was ruled out on the CT scan but however was later confirmed by an exploratory laparotomy. DISCUSSION The management of cecal volvulus requires prompt (emergency) surgical intervention while Ogilvie syndrome can be principally managed with conservative treatment. Our patient's profile was typical for both entities. The absence of air throughout all colonic segments including the rectosigmoid on plain abdominal radiographs seems to be the most important sign in the exclusion of the Ogilvie syndrome diagnosis. CONCLUSION Cecal volvulus and Ogilvie syndrome display overlapping clinical features at their time of presentation and need to be carefully distinguished. By uncertainty, an exploratory laparotomy should always be performed, in view of the reported high mortality rate of cecal volvulus if surgery is delayed.