Cecal Volvulus

 Cecum is distended and lumen narrowed by medial folding and displacement, without a twist






IMAGING




• Radiography: Dilated, air-filled cecum in LUQ or abdominal midline
image Single, long air-fluid level within cecum (upright or decubitus film)

image Moderately distended gas or fluid-filled small bowel, little gas in distal colon

image Markedly dilated cecum that appears upside down and backward with ileocecal valve directed laterally

• Additional CT signs
image Whirl sign: Tightly twisted colonic wall and ileocolic mesenteric vessels

• Best imaging test: CT in axial and coronal planes


TOP DIFFERENTIAL DIAGNOSES




• Sigmoid volvulus

• Acute ileus

• Distal colon obstruction

• Ogilvie syndrome


PATHOLOGY




• Embryology/anatomy
image Right colon is incompletely fused to posterior parietal peritoneum

• There are many causes of colonic distention, but ligamentous laxity is necessary for cecal volvulus to occur


CLINICAL ISSUES




• Accounts for 1/3 of colonic volvulus cases

• Complications: Ischemia, necrosis, perforation

• Treatment: Colonoscopy to reduce volvulus, surgery to prevent recurrence


DIAGNOSTIC CHECKLIST




• Rule out ileus, Ogilvie syndrome

image
(Left) Graphic shows a twist (volvulus) image of the ascending colon, obstructing the lumen and blood supply. The cecum image on the mesentery is dilated and displaced toward the left upper quadrant (LUQ).


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(Right) Supine radiograph shows a gas-distended segment of bowel (cecum) image within the mid abdomen. The base of the cecum is directed toward the upper quadrant, and the ileocecal valve image is directed laterally. Small bowel is gas-distended, whereas the left colon is relatively collapsed.

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(Left) Axial CT in the same case shows a markedly distended cecum image and a twisted (“whirled”) ileocolic mesentery image within the right lower quadrant.


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(Right) Coronal reformatted CT in the same case shows the markedly distended midline cecum image. The cecum is upside down and backward, with the ileocecal valve image pointed laterally. Coronal-reformatted CT is usually the most definitive study to show the characteristic features of cecal volvulus.


TERMINOLOGY


Synonyms




• Volvulus of cecum and part of ascending colon


Definitions




• Rotational twist of right colon on its axis, resulting in progressive distention and potential ischemia

• Cecal bascule
image Cecum is distended and lumen narrowed by medial folding and displacement, without twist


IMAGING


General Features




• Best diagnostic clue
image Markedly dilated cecum that appears upside down and backward with ileocecal valve directed laterally

Nov 16, 2016 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Cecal Volvulus
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