Thread by @RyanChristieMD

#Wetread Case 19

Hx: Abdominal Pain

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#Wetread Case 19 Answer: Cecal volvulus

= torsion of the cecum around it's mesentery
~10% of intestinal volvuli
30-60yo
often prior abd surgery or pelvic mass
present as prox colon obstruction (pain,n,v, distention)

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Cecal volulus:
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:
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 torsion/obstruction

Cecal Volvulus:
Treatment:
Surgery vs colonscopic decompression

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 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)?

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