Presentation
2 days of abdominal pain. On examination tender across lower abdomen with vague fullness.
Patient Data
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.
The cecum 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 ileocecal valve is "open" with some reflux of gas into distal small bowel. There are no signs of cecal ischemia or perforation. A small volume of free fluid is noted.
These annotated images show how the cecal pole becomes displaced to the left upper quadrant in cecal volvulus, and if the ileocecal 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 cecal 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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