Clinical Presentation

A 55-year-old woman presents with intense lower abdominal pain and distension.

Further Work-up

(A) Supine frontal abdominal radiograph shows markedly dilated middle to left bowel loop (arrows) with a caudal cleft, giving it the appearance of a coffee bean. No other dilated bowel is noted. (B) Single-contrast barium enema shows a dilated cecum projecting over the midline (arrowheads). After the radiograph was obtained, cecal dilatation diminished. (C) Compression view shows an apple-core lesion, consistent with colon carcinoma (arrows).

Differential Diagnosis

• Cecal volvulus caused by colon carcinoma: This is the only possible diagnosis, given the cecal obstruction, the resolution before or during the barium enema, and the apple-core stricture.

• Sigmoid volvulus: