Presentation
A middle age male complains of abdominal pain since 7 days & by US examination, a mass is seen in the right abdominal quadrant.
Patient Data
Two air-fluid levels are seen in the erect radiograph, the larger being in the right upper quadrant.
A mass-like structure is seen in the right upper quadrant.
The markedly dilated cecum is located in the right upper abdominal quadrant. Its transverse diameter is more than 10 cm in its widest portion. It shows air-fluid level, thickened walls & stranding densities in the surrounding mesentery. There is twisting of the medial side of mesenteric fat & vessels resulting to a tornado-like appearance (whirl sign). Dilated fluid-filled small bowel loops are seen. The rest of the colon are collapsed. The duodenum is collapsed and failed to cross the midline. There is an abnormal orientation of the SMA & SMV suggesting malrotation.
A series of operative photo of cecal volvulus.
The operative photo and details are courtesy of Dr/ Wael Farouk, G. Surgery Consultant, RCMC.
Case Discussion
Cecal volvulus means torsion of the cecum around its own mesentery. It may result to obstruction. Demonstrated in this case is marked proximal bowel dilatation up to 10 cm with increase risk of bowel perforation and fecal peritonitis.
The whirlpool sign (also known as the whirl sign) is seen when a structure twist on itself. It is described here owing to cecum rotates around its own cecal mesentery.