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Cecal volvulus

Case contributed by Kosuke Kato
Diagnosis certain

Presentation

1 day history of sudden onset severe generalized abdominal pain, nausea and vomiting. Generalized peritonism on examination.

Patient Data

Age: 40
Gender: Female
ct

Marked distention of the cecum measuring 9cm in maximum diameter. Whirl pool sign in the right iliac fossa with relative collapse of the distal large bowel loops.  Mild dilatation of the distal small bowel loops indicating an incompetent ileocecal valve. No free gas to suggest perforation. Moderate volume of free fluid in the pelvis. 

Incidental lobulated hypodense pancreatic tail lesions measuring 18 x 14mm. No pancreatic duct dilatation. 

Normal appearance of the liver, gallbladder, spleen and kidneys.

Case Discussion

This case illustrates a cecal volvulus. 

The patient underwent an urgent laparotomy. Intra-operatively, the colon was untwisted and a right hemicolectomy with side-to-side anastomosis of the ileum to transverse colon was performed for ischemic bowel. No features of neoplasm. 

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