Findings of Cecal Volvulus at CT

Abstract

When cecal volvulus is suspected, the absence of distal colonic decompression on CT topograms makes the diagnosis very unlikely. Whirl, ileocecal twist, transition points, X-marks-the-spot, and split wall have high specificity for cecal volvulus.

Cecal Volvulus: A Rare Cause of Intestinal Obstruction

“…Although abdominal radiography may show the features of an intestinal obstruction, including widespread small intestinal air-fluid levelsand/or distended cecum in the right abdomen, making the cecal volvulus diagnosis is difficult or impossible in most of the cases [2,3,6], as was in ours. Doppler USG may lead to make a definite diagnosis by showing twisted mesenteric vessels [6], and CT may be more diagnostic by demonstrating cecal distension, cecal apex in left upper quadrant, mesenteric whirl, ileocecal twist, and small bowel distension [4,7]. Despite the identified diagnostic features, cecal volvulus is rarely diagnosed correctly at the time of presentation due to the low incidence of the disease [2,3].…”

“…Although it generally present as a small bowel obstruction [2], clinical symptoms, signs, and routine laboratory tests arenot spesific to the disease [3], whileCT is more diagnostic [4]. Surgical intervention is the only treatment of cecal volvulus [1].…”

Clinics in diagnostic imaging (171)

“…These factors presumably cause increased caecal displacement or hyperperistalsis. (2,5) Clinically, patients tend to present with recurrent intermittent abdominal pain or acute intestinal obstruction. Close to half of patients who present with acute obstruction due to caecal volvulus have a history of preceding recurrent intermittent abdominal pain that is localised to the right lower quadrant of the abdomen.…”

“…Although CT is often the best imaging tool in the diagnosis of caecal volvulus, (5) plain radiography is usually the first-line imaging investigation used in the evaluation of central abdominal pain.…”

Cecal volvulus

“…4 However, findings on radiography are often not diagnostic; CT is the definitive study for confirming the distended cecum and associated "whirl sign" of twisted mesenteric vessels and fat specific to the diagnosis. 1 Conservative management is not recommended because of the high risk of ischemia, and surgical detorsion alone carries a high rate of recurrence (20%-75%). 3 Retrospective case series have shown the lowest morbidity and recurrence with surgical cecal resection, as opposed to alternative procedures such as cecopexy and cecostomy.…”