Caecal Volvulus

This patient presented with abdominal pain, distension and 3 days of obstipation. The supine abdominal film shows a markedly distended loop of bowel in the right upper quadrant, with a “coffee-bean” contour. The caecum cannot be identified in the right lower quadrant. There is evidence of associated small-bowel obstruction, with distended centrally-located loops. An erect film (not shown) showed a long air-fluid level in the right upper quadrant, and several small bowel air-fluid levels. An abdominal CT was requested, and confirmed the findings. It also showed moderate peritoneal free fluid. The volvulus was reduced at laparotomy.
Caecal volvulus accounts for 11% of all intestinal volvulus. It generally occurs between 30-60 years of age, and patients may have a prior history of abdominal surgery or mass. Treatment is generally operative, unlike sigmoid volvulus which may be reduced by colonoscopy.
Reference: Moore CJ, Corl FM, FIshman EK. CT of Cecal Volvulus - Unraveling the Image. AJR 2001; 177:95-98.
Credit: Dr Laughlin Dawes
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