Presentation
Abdominal discomfort.
Patient Data
The cecum is dilated and inverted, positioned in the left hemiabdomen. If you carefully scroll the coronal images, you can follow the twisted segment of ascending colon to the right upper quadrant/hepatic flexure, and note the rest of the colon is decompressed. The small bowel is mildly dilated leading into the volvulized cecum. Medium hiatal hernia with reflux. Small ascites.
Annotated coronal images.
Case Discussion
This is a typical case of cecal volvulus, but a good reminder on how challenging these cases can be to confidently diagnose and the importance of carefully tracing out bowel loops on both axial and coronal images to understand the imaging picture.
In this case, the scout image can be helpful in raising your concern of cecal volvulus, with left hemiabdomen positioning of the colon. If you carefully trace this in the coronal plane, you can see the twisting segment of the ascending colon leading into the inverted cecum from the hepatic flexure. Can you find the terminal ileum? It's above the twisted segment of ascending colon on the coronal images. Be sure to trace this anatomy on axial after you figure it out on coronal images.