Letters to the Editor 1130-0108/2010/102/5/338-339 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS Copyright © 2010 ARÁN EDICIONES, S. L. REV ESP ENFERM DIG (Madrid) Vol. 102, N.° 5, pp. 338-339, 2010 Cecal volvulus in a cardiac transplant patient. Report of a case and critical review Key words: Cecal volvulus. Cardiac transplantation. Gastroin- testinal complications. Dear Editor, Theacuteabdominalcomplicationsinthecardiactransplant recipients represents a big challenge, demanding an early diag- nosisduetoitshighmortality(20-25%).Mostofthemoccuron thefirst30postoperativedays,whenothereventscanmakethe appropriatediagnosismoredifficult(1-3). We report the case of cecal volvulus in the early postopera- tiveperiodofacardiactransplantpatient,andacriticalreview. Case report A 61 years-old male, diagnosed of dilated cardiomyopathy, secondary to coronary artery disease, with ejection fraction of 23%,wassenttoourcenterforhearttransplantation.Hisprevi- ous history showed appendicectomy, hypertension (type 2), di- abetes,chronicrenalinsufficiencyandpreviouscoronaryartery bypasssurgery. The heart transplant was performed with bicaval technique. The ischemia time was 280 min with cardiopulmonary bypass duration of 200 min. The patient required vasopressors and blood transfusion due to tendency to hipotension after surgery. Prophylactic antibiotics and immunosuppressive regime based on corticosteroid, daclizumab and mycophenolate mofetil was prescribed. In the early postoperative period the patient suffered diarrhea and fever. Clostridium difficile was ruled out based on toxin A andBassessmentinthestoolsamplesbyenzymunoanalysis. On the 10 th postoperative day, the patient had severe acute abdominalpain,abdominaldistensionandleukocytosis(35.000 L/mm 3 ).AnabdominalCTshowedcecaldistension–12cmdi- ameter–, with signs of cecal volvulus type “variant cecal bas- cule”(Fig.1). An urgent laparotomy confirmed the diagnosis of cecal volvulus with signs of transmural necrosis without perforation. Arightcolectomywithprimaryileo-colicanastomosiswasper- formed. The patient developed an uneventful postoperative course. The pathological report confirmed transmural necrosis with di- lation,congestionofmucosalandhemorrhage.Thepatientwas discharged on 45 postransplant day, with an excellent graft function,withafractionejectionof77%. Discussion Cecal volvulus accounts for 20-40% of all colonic volvuli (4). They are more frequent in women; prior abdominal surg- eries, adhesion, mobile cecum, distal colonic obstruction and hiperperistalsishavebeenimplicatedascausativefactors(4). Fig. 1. Coronal and axial TC images shows a 12.3 cm distension of the cecum (*), with normal morphology at the level of the ascending colon (arrow).