Volvulus of the cecum simulating anorexia nervosa

A 20 yr old female student began dieting at the age of 15 because of slight overweight. No organic or endocrine deficiency was found. Anorexia nervosa was diagnosed and she was admitted for psychiatric treatment. Psychoanalysis was tried several times but without any success. Prior to admission to the hospital, she had constant pain in the right lower quadrant of the abdomen with nausea but no vomiting for two days and obstipation for four days. Physical examination revealed a poorly nourished female 164 cm in height and only 29 kg in weight. Her tongue was dry. The abdomen was distended, especially on the right side. Diffuse tenderness without guarding was present. No intestinal sounds were heard. Splashing was noted on auscultation. Plain abdominal radiography showed dilated loops of intestines in the right lower abdomen and some fluid levels. Low small bowel obstruction or obstruction in the cecum was diagnosed and a laparotomy was performed through a right, low paramedian incision. The cecum was twisted 180 degrees counterclockwise.