Caecal volvulus
Case contributed by:
Dr Jens Christian Fischer
Presentation:
5 day history of abdominal pain and lack of bowel action.
Patient Data:
Age: 60
Gender: Male
From the case:
Caecal volvulus
Modality:
X-ray
From the case:
Caecal volvulus
Modality:
CT
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Caecal volvulus
Case Discussion:
The first x-rays were misinterpreted in the ED as free abdominal air.
During subsequent laparascopy the surgeons couldn't find any site of perforation but did identify a distended loop of large bowel between the right lateral diaphragm and the liver. They sugested a stenosing process of the transverse colon.
The CT reveals, as the main finding, a caecal volvulus with the classic "whirl sign" and some distended, fluid filled small bowel loops with air-fluid levels, consistent with an obstructive small bowel ileus.
The free abdominal air on the CT is attributable to the recent laparascopy.
Incidental findings include:
- cosolidation in the middle lobe
- atelectasis of the right lower lobe
- partial duplication of the right collecting system (ureter fissus)
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