Cecal volvulus with perforation

Case contributed by Ammar Haouimi
Diagnosis almost certain


Signs of intestinal obstruction.

Patient Data

Age: 90 years
Gender: Female

The scout view shows grossly distended cecum lying horizontally in the upper pelvic region with distended small bowel loops and free gas in the peritoneal cavity under the diaphragm, around the liver and around small bowel loops.

The CT scan demonstrates:

  • markedly distended cecum (diameter ~16 cm) lying horizontally, containing air-fluid level with preserved colonic haustral pattern

  • twisting of the proximal ascending colon and its mesentery, giving the "whirlpool appearance" well-demonstrated in the right iliac fossa. The rest of the colon is decompressed

  • a focal defect of the anterior cecal wall probably indicating site of perforation

  • other CT findings:

    • sliding hiatal hernia

    • moderately distended gallbladder with multiple small gallstones. Moderately dilated CBD with small choledocholithiasis (confirmed by ultrasound)

    • osteoporotic vertebral compression fractures

Annotated image

Annotated images: the green arrows indicate the probable site of perforation

Case Discussion

CT features of perforated cecal volvulus.

At surgery, there were three sites of cecal perforation and the patient had a right hemicolectomy with ileostomy.

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