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Findings:The initial scout film shows marked distension of a loop of bowel in the mid abdomen. Subsequent administration of barium contrast shows the column of contrast ending in the region of the proximal ascending colon with beak-like configuration.
Diagnosis:Cecal volvulus
Discussion: Cecal volvulus is a condition characterized by twisting or folding of the right colon so that the cecum is located in the mid abdomen or left upper quadrant. This condition accounts for about 1 to 2% of all intestinal obstruction and about one third of all cases of colonic volvulus. Approximately 90% of patients with cecal volvulus have an axial twist of a segment of the riight colon while about 10% have a cephalad fold of the cecum across the ascending colon which is termed a cecal bascule. This latter entity has been challanged by others who believe that these patients have a focal adynamic ileus of the cecum. A mobile cecum is necessary to develop a cecal volvulus. About 11 to 22% of people have defects in the fixation of the right colon to the abdominal wall.
Clinically, patients with cecal volvulus presents with acute onset of severe, colicky pain, nausea, vomiting, and constipation. Abdominal distension may develop with a compressible mass extending from the right lower quadrant to the mid abdominal region. Some patients can present with chronic abdominal symptoms if the cecal volvulus resolves spontaneously and then subsequently occurs. Cecal volvulus have been described to occur in a variety of clinical situations such as colonoscopy, barium enema, and pregnancy. Surgical reduction is usually needed. Nonoperative techniques such as barium enemas and colonoscopy for the reduction of cecal volvulus are less successful than for sigmoid volvulus.
Most cases of cecal volvulus will have a characteristic appearance and can be definitely identified on plain films. Plain films may show a dilated, air-filled cecum usually located in the left upper quadrant. The cecal valve may produce a soft tissue indentation giving a coffee bean or kidney shaped appearance to the air-filled cecum. Early on, little air is seen in the small bowel if the ileocecal valve is competent. A contrast enema study can show "beaking" at the point of the volvulus.
References:
1. Gore RN, Levine NS, Laufer I: Textbook of Gastrointestinal Radiology,
1994, WB Saunders Company, Philadelphia.
2. Sabasten DC: Textbook of Surgery, 1991,
WB Saunders Company, Philadelphia.
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