Case of the Week: Cecal Volvulus (X-ray & CT)

In this inaugural case of the week radiology lecture, we discuss the imaging appearance of cecal volvulus!

Key points include:

Cecal volvulus occurs when there is twisting of cecum around the mesentery with proximal large bowel obstruction.
Cecum normally <9 cm, rest of large bowel <6 cm.
Topogram (scout view) extremely helpful.
Vector typically points towards LUQ, but instead of worrying about vector direction, look for proximal dilated small bowel (as opposed to large bowel) to differentiate from sigmoid volvulus.
Complications include pneumoperitoneum = bowel perforation (Rigler’s sign, falciform ligament sign) and pneumatosis = cecal ischemia.

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