Caecal volvulus

Case contributed by Dr Jeremy Jones

Presentation

Acute abdominal pain. Tender with guarding.

Patient Data

Age: 65
Gender: Male
Race: Caucasian
Modality: X-ray

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 caecal volvulus.

Modality: CT

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 caecal 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 caecal volvulus.

Caecal volvulus will often present as a large dilated loop of bowel to the left of midline as the mesentery that the caecum is suspended on twists.

Features here are of caecal volvulus with accompanying small bowel obstruction.

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Case Information

rID: 6061
Case created: 14th Apr 2009
Last edited: 6th Jan 2016
Inclusion in quiz mode: Included

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