Although bowel gas patterns may not be classical

Although bowel gas patterns may not be classical, because the cecum can be displaced to any part of the abdominal cavity mimicking the sigmoid volvulus or distended stomach, cecal volvulus or cecal bascule should be considered in the differential diagnosis of patients presenting with pain, vomiting, and abdominal distension and whose abdominal X-rays reveal a large, dilated, haustrated, air-filled bowel loop with an air–fluid level (as observed in our case). In the current case, cecal bascule was only diagnosed intraoperatively because of its rarity in children and the absence of any precipitating factor, except for chronic constipation, suggesting this condition. Compared with the classical type of cecal volvulus, the features suggestive of small bowel obstructions may not be observed on abdominal radiographs in the case of cecal bascule (as observed in our case). The diagnosis should be established using follow-up films, MK2 inhibitor enema, or CT. Using CT for investigations is crucial. The signs described for volvulus in the literature are the coffee bean sign on radiographs, bird\'s beak sign on contrast enema, and whirl, coffee bean, and bird\'s beak signs on CT scans. In cecal bascule, contrast enema reveals the anterior projection of the gas-filled cecum to the contrast-filled ascending colon and CT reveals an abnormally positioned cecum and a U-shaped distended bowel segment. The differential diagnoses of cecal bascule are sigmoid volvulus, midgut volvulus, colonic obstruction, and classical type cecal volvulus. Nonsurgical treatment with colonoscopy is relatively ineffective, with a success rate of less than 30%. We did not perform contrast enema or colonoscopic reduction of the cecal volvulus. The definite consensus on surgical management is deficient and should be individualized depending on the general condition of the patient and viability of the bowel. Early surgical intervention is the definitive treatment in case of impending perforation. Detorsion, cecopexy and cecostomy are not preferred in children because of their complications, including recurrence. We suggest resecting the cecum with anastomosis in pediatric patients with cecal bascule because it has the least recurrence.
Introduction Angiosarcoma is a rare type of liver cancer that represents only 2% of primary hepatic malignancies and ∼4% of all angiosarcomas of different origins. The spontaneous rupture of a hepatic angiosarcoma may induce severe intra-abdominal bleeding and is associated with higher morbidity and mortality. Transarterial embolization (TAE) may be effective in obtaining hemostasis in most hepatic malignancies. In most reported cases, TAE has been performed as the initial treatment. However, ruptured tumors may induce recurrent internal bleeding and cannot be accessed by TAE because they are supplemented by multiple blood sources. Following TAE with hepatectomy is the only definite curative treatment available for hepatic angiosarcomas; moreover, it can prevent repeated, potentially fatal internal bleeding. We present a case of ruptured hepatic angiosarcoma treated by TAE without a subsequent surgical resection. We identified subsequent recurrent bleeding that was caused by an angiosarcoma and could not be controlled by TAE. Successful but risky liver resection was performed as a salvage treatment to achieve hemostasis.
Case Report The patient had experienced three similar episodes within the previous 2 months. Initially, she was referred to a nearby hospital with similar presentation and a ruptured liver tumor was highly suspected. TAE was performed to stop the bleeding. Upon admission, according to the patient, a following tumor resection was not performed because of the high operative risk. In the following month, she experienced two similar episodes. Abdominal computed tomography (CT) revealed one heterogeneous tumor in the posterior segment, hemoperitoneum, and contrast extravasation (Figures 1A and 2A). Two angiographies for TAE showed no active arterial bleeding (Figures 1B and 2B). Conservative treatment was applied in both episodes.