Presentation
Sharp abdominal pain for 12 hours, which began in the right lower quadrant, vomiting. SBO? Bowel perforation?
Patient Data
Grossly distended large bowel loop with a 10 cm diameter and a large air-fluid level. The sigmoid contains a normal amount of air, and there are smaller air-fluid levels in the small bowel too.
Findings altogether favor cecal volvulus with associated small bowel subileus.
CT confirms the cecal volvulus with the lead point of the twist originating from the right lower quadrant, whilst the rest of the large bowel is largely empty. Associated small bowel distension and bowel wall thickening of the ascending and transverse colon.
Other findings: status post NG tube insertion, an about 45 mm infrarenal, partially thrombosed abdominal aortic aneurysm, severe atherosclerosis, occlusion of the right common ilac artery, liver cysts, prostate enlargement, right inguinal hernia with small amount of free fluid, prior L3 vertebral compression.
Case Discussion
The left lateral decubitus AXR makes diagnosis of cecal volvulus more challenging but subtle signs such as the small bowel stasis, and the aerated sigmoid altogether lead towards the pathology.
Also contributed by Dr Anita Németh
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