Caecal volvulus

Case contributed by Dr Jens Christian Fischer

Presentation

Five day history of abdominal pain and lack of bowel action.

Patient Data

Age: 60
Gender: Male
X-ray

The x-rays taken in the ED show a distended loop of large bowel with a liquid-air level between the right diaphragm and the liver. Furthermore they demonstrate some distended loops of the distal small bowel.

CT

The axial CT-slices clearly reveal a small bowel obstruction due to a caecal volvulus. Notice the classic "whirl sign".

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:

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Case information

rID: 12823
Case created: 15th Jan 2011
Last edited: 25th Apr 2016
Inclusion in quiz mode: Included

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