Presentation
Acute abdominal pain and distention
Patient Data
Dilated loop of bowel in the right upper quadrant with a whirlpool sign. The afferent loop of terminal ileum enters with proximal small bowel obstruction to this.
No perforation, pneumatosis or collection is identified.
Cecal volvulus was confirmed on laparotomy.
Case Discussion
Cecal volvulus accounts for 10% of intestinal volvuluses and is usually (although not this case) in younger patients.
Predisposing factors include:
1. developmental failure of peritoneal fixation allows for hypermobility of cecum
2. restriction of the bowel at a fixed point within the abdomen acting as a fulcrum for rotation.
This case is somewhat unusual as the volvulus presents in the right upper quadrant as opposed to the left.
Laparotomy was required with primary anastomosis. Complications include significant small bowel obstruction or ischemic complications.
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