This paper present a case of ileocecal volvulus causing extensive intestinal necrosis.
A 78-year-old woman was admitted to the hospital because of abdominal pain and symptoms of intestinal obstruction. Plain abdominal X ray film showed air-fluid level and a markedly distended bowel with gas in the right abdomen. Abdominal CT scan revealed an abnormally distended and thickened wall of the colon. The right lobe of the liver and right kidney were displaced and it was remarkable for the right kidney which was displaced to the middle retroperitoneal space. Bloody ascites was confirmed by a peritoneal puncture and we performed an emergency operation under a diagnosis of strangulating obstruction. At laparotomy ischemic change and necrosis of the ileocecal portion were identified, and it was twisted clockwise by 180 degree and was strangulated by a fibrous band. There was further extensive bowel necrosis due to mesenteric circulatory disturbance. A broad resection including the small intestine and the right side of the colon was performed. The remnant small intestine was approximately 50cm in length. Three months after the initial surgery, the alimentary tract was reconstructed by jejunocolostomy. The patient was weaned from total parenteral nutrition and was discharged from the hospital on 145th postoperative day. This is the first case of ileocecal volvulus complicated with necrosis of the extensive intestine in Japan.