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)

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)?