Season 9 Case 19

Season 9 Jan 31, 2021

History: abdominal pain and distention



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):


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:

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)

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)?



Professor of the Darkroom Arts

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