Presentation
Severe upper abdominal pain, mild distention, nausea
Patient Data
Distended loop of large bowel measuring up to 11 cm projected over the left side of the abdomen. No free intraperitoneal gas.
Distended cecum measuring up to 10.5 cm in diameter. Terminal ileum and ileocecal valve are relatively superior in the abdomen. Sharp transition point of the cecum inferiorly, with apparent 'whirlpool' appearance of the mesentery at the transition point. The large bowel distal to the transition point is entirely collapsed. Fecalised material in the distal ileum. Small volume free abdominal and pelvic fluid. No discrete collection. No free gas.
Gallstone in an otherwise unremarkable gallbladder.
Normal liver, adrenals, kidneys, pancreas and spleen.
Severe T9 and moderate T12 osteoporotic wedge fractures. No concerning bony abnormality.
Opinion:
Appearances in keeping with cecal volvulus, with cecum measuring up to 10.5 cm in diameter. No perforation.
Case Discussion
Good plain film of cecal volvulus with CT correlation.
Main points of note - dilated large bowel loop but no distal large bowel dilatation and cecum is not visible in normal position in right lower quadrant, all together in keeping with cecal volvulus.
Useful to note cecal diameter as increasing diameter increases risk of perforation.
The patient proceeded to surgery for right hemicolectomy.
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