Season 9 Case 19

Hx: Abdominal pain and distention

Season 9 Case 19

History: abdominal pain and distention


Answer:

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Answer: Cecal volvulus

= torsion of the cecum around it's mesentery

  • ~10% of intestinal volvuli 30-60 yo
  • often prior abd surgery or pelvic mass
  • present as prox colon obstruction (pain,n,v, distention)

Cecal Volvulus
2 types:

  • Axial - twists about axial plane (either way) but remains in RLQ
  • Loop type - twists and inverts moving to LUQ

Bascule is a variant where the cecum doesn't twist, just folds up anteriorly (NO torsion!)

From UpToDate (a=axial, b=loop, c=bascule):

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Cecal Volulus Imaging:
X-ray: marked dilated colon loop extending from RLQ to LUQ (remember cecum dilation is >9cm)

  • -haustra usually maintained
  • -can have SINGLE air-fluid level

CT: exactly what you expect - dilated cecum with "bird beak" at site of orsion/obstruction

cecal-volvulus-ax

Cecal Volvulus:

Look for wall thickening, pneumotosis, free air, arterial cut-offs or venous dilation/obstruction - all concerning signs for ischemia

Often when mesentery twists it pulls in other loops (see sigmoid below)
cecal-voluvlus-cor

Treatment:
Surgery vs colonscopic decompression

Cecal vs Sigmoid volvulus

Not always as simple as it sounds.

  1. Loop for straight (cecal) vs upside down U-shaped (sigmoid) dilated colon loop

  2. Is the descending colon decompressed (cecal) or dilated (sigmoid)?