GOOD NEWS: We have fixed the DICOM uploading problem. New cases should work fine. More info

Cecal volvulus

Case contributed by Jens Christian Fischer
Diagnosis certain


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

Patient Data

Age: 60 years
Gender: Male

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.


There is dilated gas-filled bowel in the right upper quadrant. Bowel gas cannot be seen in the rest of the colon.

The axial CT-slices clearly reveal a small bowel obstruction due to a cecal 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 suggested a stenosing process of the transverse colon.

The CT reveals, as the main finding, a cecal 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:

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.