Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

288 Cat Scratch Disease Cecal Volvulus

management

■Symptomatic treatment for pain, fever

specific therapy

■Classic CSD – a benign, self-limited disease that resolves sponta-

neously in several months

■Azithromycin may hasten resolution of adenopathy, but is not rou-

tinely recommended. Consider for severe systemic symptoms or

suppuration.

■Unclear if therapy affects resolution of retinitis, hepatosplenic gran-

ulomatous disease, osteitis or encephalopathy, but many would treat

with doxycyline or erythromycin with or without rifampin

follow-up

■Spontaneous resolution may be slow and intermittent clinical

assessment is indicated, particularly when the diagnosis is clinical.

complications and prognosis

■Full recovery is the rule.

■Suppuration of lymph nodes in 15%

■Rare permanent loss of vision, but most recover full visual acuity

even without therapy

Cecal Volvulus......................................

BASSEM SAFADI, MD and ROY SOETIKNO, MD, MS

history & physical

Risk Factors

■incomplete fixation of the right colon mesentery to the lateral

abdominal wall

■two types: ileocolic (90%), cecal bascule (10%)

■cecal volvulus causes small bowel obstruction

Symptoms & Signs

■crampy abdominal pain, nausea, vomiting and abdominal disten-

tion.

■acute, but can sometimes be insidious

■abdominal distention and tympany

■peritoneal signs, fever, and leukocytosis suggest ischemia and per-

foration