Presentation
Severe right iliac fossa pain.
Patient Data
A large dilated loop of colon is noted in the central abdomen appearing to arise from the right iliac fossa measuring up to 9 cm. A swirl of mesenteric vessels is noted in the right iliac fossa leading into the dilated bowel. There is a blind ending tubular structure arising from the tip of the distended bowel, compatible with an appendix arising from the cecal tip. A moderate volume of peritoneal free fluid is present. No free gas. The remainder of the colon is unremarkable. No dilated small bowel loops. The liver, spleen, pancreas, adrenals and kidneys are unremarkable. Stomach is distended with oral contrast. Imaged lung bases are clear. No suspicious osseous lesions.
Conclusion:
Findings in keeping with cecal volvulus, dilated up to 9 cm, with peritoneal free fluid but no free gas.
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