Presentation
Acute abdominal pain. Tender with guarding.
Patient Data
Marked gaseous distension of small bowel loops and a large gas-filled viscus on the left side of the abdomen. Features here suggest small bowel obstruction secondary to a cecal volvulus.
There is small bowel obstruction with distended gas- and fluid-filled loops of small bowel as suggested on the plain film.
The large left-sided bowel loop is demonstrated anteriorly as a closed-loop obstruction and at its base, there is swirling of mesenteric vessels in keeping with cecal volvulus.
Case Discussion
Where there is significant dilatation of a hollow viscus, there are limited differentials. If it were midline and lower in the abdomen we could think about sigmoid volvulus.
However, if there is associated small bowel obstruction the level of obstruction is likely to be more proximal. If there is a hugely dilated hollow viscus and accompanying small bowel obstruction, think cecal volvulus.
Cecal volvulus will often present as a large dilated loop of bowel to the left of midline as the mesentery that the cecum is suspended on twists.
Features here are of cecal volvulus with accompanying small bowel obstruction.
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