Cecal volvulus

Case contributed by Dr Jens Christian Fischer

Presentation

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

Patient Data

Age: 60 years
Gender: Male
X-ray

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.

CT

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:

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