Caecal volvulus

Case contributed by Dr Vikas Shah

Presentation

2 days of abdominal pain. On examination tender across lower abdomen with vague fullness.

Patient Data

Age: 40 years
Gender: Female
X-ray

Abdominal x-ray

Distended gas filled viscus with base pointing towards right lower quadrant and a paucity of gas within the distal large bowel. Some gas filled small bowel loops in the right lower quadrant.

CT

CT Abdomen

The caecum has volved and lies in the left upper quadrant. There is a twist in the nearby mesentery with a normal location of the remaining large bowel. The ileocaecal valve is "open" with some reflux of gas into distal small bowel. There are no signs of caecal ischaemia or perforation. A small volume of free fluid is noted.

Annotated image

These annotated images show how the caecal pole becomes displaced to the left upper quadrant in caecal volvulus, and if the ileocaecal valve is incompetent, gas may reflux into distal small bowel loops. The vessels around the twisting bowel form the whirl sign.

Case Discussion

In a caecal volvulus, the base of the distended bowel loop arises from the right lateral abdomen or right lower quadrant, in contrast to a sigmoid volvulus where it arises from the pelvis. In both cases the loop usually points towards the left upper quadrant. The whirl sign of twisting mesenteric vessels in seen as an indicator of a twist in the bowel.

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Case information

rID: 54998
Case created: 13th Aug 2017
Last edited: 4th Dec 2017
Inclusion in quiz mode: Included

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