33-year-old female patient presents with right iliac fossa pain and tender lower abdomen. Perforated appendicitis?
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There is a point of apparent torsion of the right colon associated with prominent dilation of the caecum and proximal colon, with the caecum measuring 11 cm in diameter. This is a closed loop obstruction, with two transition points (afferent and efferent) closely apposed in the right iliac fossa. Enhancement of the caecum wall cannot be reliably assessed due to the degree of distension but appears to be reduced, and the nature of obstruction means there is a high risk for ischaemia. The small bowel and the distal colonic segments are unremarkable. No evidence of free gas. Moderate volume free intraperitoneal fluid.
There is a 3.5 cm solid mass adjacent to the right posterolateral aspect of the uterus that may represent a pedunculated fibroma.
Small pleural effusion on the right.
This case demonstrates a caecal volvulus resulting in closed loop obstruction and characterising a surgical emergency. It was confirmed in the laparotomy performed shortly after the scan.