This patient presented with abdominal pain, nausea, vomiting, and distention:
These films and CT show colonic dilatation similar to last week (sigmoid volvulus). However, in contrast to last week, this is a cecal volvulus. In this CT there is marked dilatation of the cecum with a central location in the abdomen. Usually a cecal volvulus will have visible haustra as opposed to a sigmoid volvulus in which colonic haustra will not be present. Sometimes, as in the above images, the haustra are difficult to see. This also looks like it may be a more rare form of cecal volvulus called a cecal bascule. For more information I will defer to our radiology colleagues at Radiopaedia:
For all you radiologists out there, do you think this is consistent with a cecal bascule?
Why note the difference between cecal and sigmoid volvulus? The treatment can be drastically different. Sigmoid volvuli are many times amenable to acute management non-operatively (sigmoidoscopy) whereas cecal volvuli usually require open laparotomy and have a higher frequency of partial colectomy.
Author: Russell Jones, MD
References
1. Gaillard F et al. Caecal Volvulus. http://radiopaedia.org/articles/caecal_volvulus
Filed under: Abdomen XR, Abdomen/Pelvis, Abdomen/Pelvis, CT, Non-Trauma, XR Tagged: Volvulus