Jan 12, 2016 the term cecal volvulus is a misnomer because, in most patients with cecal volvulus, the torsion is located in the ascending colon above the ileocecal valve. Figure 15 infarcted cecal volvulus in a 20yearold woman. Fox published september 14, 2018 updated september 11, 2018 abdominal pain is a common complaint in children and may be due to a wide variety of conditions, both severe and benign ex, appendicitis, strep throat, constipation, and chronic recurrent abdominal pain. In contrast, colonic volvulus involves the mobile, intraperitoneal parts of the colon such as the cecum, transverse colon and sigmoid. The purpose of this study is to report the computed tomography ct features of cecal volvulus and to determine the accuracy of ct in distinguishing the three pathophysiological types of cecal volvulus. Malrotation of the intestine occurs when the normal embryologic sequence of bowel development and fixation is interrupted. Cecal volvulus is slightly less common than sigmoid volvulus and is associated with symptoms of abdominal pain and small bowel obstruction.
Clinical presentation and treatment are not significantly different from the more common axial cecal volvulus. Volvulus is 3 rd most common cause of colonic obstruction. Cecal volvulus can be associated with malrotation of the colon. Volvulus of the cecum and ascending colon radiology. Other factors must be at play, though, since 10% of population has such a long mesentery yet few develop cecal volvulus. A cecal volvulus is the rotation or torsion of a mobile cecum and ascending colon, which causes approximately 1 to 3 percent of all large bowel obstructions.
Cecal volvulus is caused by axial twisting of the cecum along with the terminal ileum and ascending colon. Normally, the cecum and ascending colon are fixed to the abdominal wall. Cecal volvulus volvulus of the cecum is a torsion of the bowel around its own mesentery that often results in a closed loop obstruction. Caecal volvulus is a rare cause of intestinal obstruction, with the bascule subtype accounting for volvulus. The early recognition of this type of colonic obstruction is of great importance for radiologist and surgeon alike. Cecal bascule is an uncommon type of cecal volvulus in which the cecum folds up over itself in an anteromedial orientation. Mar 30, 2016 midgut volvulus is a condition in which the intestine has become twisted as a result of malrotation of the intestine during fetal development. In case of a cecal volvulus this torsion comprises the terminal ileum, the cecum itself and the ascending colon. Large bowel obstruction colonic ischemia sigmoid volvulus cecal volvulus colonic stents these keywords were added by machine and not by the authors. It is caused by twisting of the caecum, which is often abnormally mobile in these patients, on its mesentery. Clinical radiology 1984 35, 6569 1984 royal college of radiologists caecal volvulus a frequently missed diagnosis. American college of radiology acr appropriateness criteria. After sigmoid volvulus, it is the most frequent type of volvulus. Infarction is usually the result of venous congestion, while the arterial supply is rarely compromised.
This film is made more challenging by the gas retained in the semidilated ascending colon. Of 189 children operated upon from 19701977 for acute intestinal obstruction, in only six children, was cecal volvulus the cause. Cecal volvulus takes place due to the torsion caused in the cecum area extension of the volvulus sigmoid volvulus can only move upwards and goes to the right upper quadrant. Leads to mobility of right colon predisposing to volvulus. Although it generally present as a small bowel obstruction, clinical symptoms, signs, and routine laboratory tests arenot spesific to the disease, whilect is more diagnostic. Two coronal reformatted ct scans of the abdomen are shown. Many of the recorded cases of acute volvulus of the cecum indicate that 21 per cent of the patients with this condition had under gone previous surgery. Volvulus can also occur in patients with duchenne muscular dystrophy due to the smooth muscle dysfunction. The pathophysiology of small bowel volvulus differs from that affecting large bowel.
Cecal volvulus can only occur in the small percentage 1125% of the population who have a developmental failure of peritoneal fixation, allowing the proximal colon to be free and mobile. For each patient, ct findings were looked for and recorded. Cases of acute abdomen, regardless of age, race, and. An intestinal volvulus is defined as a torsion of a certain part of the intestinal tract. It occurs with aspecific acute onset abdominal pain associated to nausea and vomiting, so that it often poses a diagnostic challenge for the clinician who needs radiological consultation for further. A long narrow based mesentery predisposes to volvulus. An exploratory laparotomy revealed a cecal volvulus due to a congenital band and malfixation of the cecum. Cecal volvulus is due to the cecum twisting around the ascending colon thus leading to small bowel obstruction. Abnormally long mesentery of cecum and ascending colon.
When cecal volvulus exists, obstruction leads to distension, ischemia, gangrene and perforation, and therapy should be imminent. Cecal volvulus definition of cecal volvulus by medical. Radiography, fluoroscopy, and computed tomography are the imaging methods most often. Cecal volvulus is twisting of the cecum and ascending colon. Contrastenhanced ct image shows a dilated cecum located high in the midline. The clinical symptoms associated with volvulus are often nonspecific and include pain and nausea with vomiting. Cecal volvulus means torsion of the cecum around its own mesentery. Sigmoid vs cecal volvulus sigmoid volvulus is the twisting of the sigmoid colon of the large intestine. Volvulus is 3 rd most common cause of colonic obstruction following obstructing carcinoma and inflammatory stricture. Sigmoid volvulus sv is known to be encircling of sigmoid colon around its own base. Twisting of loop of intestine around its mesenteric attachment site may occur at various sites in the gi tract.
Cases of volvulus were described in ancient egypt as early as 1550 bc. Cecal volvulus however can go almost anywhere and can even be located in the pelvis. Plain radiograph abdominal radiographs will show a large, dilated loop of the colon, often with a few gasfluid levels. It is associated with significant morbidity and mortality if left undiagnosed. Dilated, airfilled cecum in luq or abdominal midline single, long airfluid level within cecum upright or decubitus film moderately distended gas or fluidfilled small bowel, little gas in distal colon markedly dilated cecum that appears upside down and backward. The radiologist can make the diagnosis correctly in many instances, and on this basis the surgeon is guided to proper remedial procedures and, eventually, to prevention of a recurrence. In the lower photo, the white arrow indicates the cecum c flips from the right lower quadrant to the left upper quadrant, rotating on its mesentery. The diagnosis of an infarcted cecal volvulus was confirmed at exploratory surgery.
That is, the formation of a large dilated caecal pole head, with one or two further segments body. Note the ring of gas in the cecal wall arrows, a finding suggestive of pneumatosis. Cecum is distended and lumen narrowed by medial folding and displacement, without a twist imaging radiography. Aug 20, 2016 caecal volvulus is a rare but important condition, as it carries a high mortality rate. We present a case of cecal volvulus in a 50 years old female. The clinical symptoms associated with volvulus are often nonspecific and. It generally occurs in patients between 30 and 60 years of age and accounts for about 2540% of all colonic volvulus, being responsible for % of cases of intestinal obstruction. Volvulus of the gastrointestinal tract rsna publications online. Intestinal volvulus is a broad term that describes the torsion of bowel around its mesentery. Cecal volvulus is a condition of intestinal malrotation in which there is axial twisting which involves the cecum, terminal ileum, and the ascending colon. Abdominal xray abnormal bowel gas pattern volvulus.
Cecal volvulus is a rare cause of intestinal obstruction thatoccurs 11. Approximately 60% of mechanical largebowel obstructions lbos are caused by malignancies, 20% by diverticular disease, and 5% are the result of colonic volvulus. Dilated, airfilled cecum in luq or abdominal midline single, long airfluid level within cecum upright or decubitus film moderately distended gas or fluidfilled small bowel, little gas in distal colon markedly dilated cecum that appears upside. In general, a partial malrotation is necessary for cecal volvulus to occur, because the cecum and parts of the ascending colon are involved. The differential diagnosis in this case includes both cecal bascule and cecal volvulus. Radiology masterclass caecal embryo sign in caecal volvulus, the dilated caecum takes on a shape similar to a mammalian embryo. Cecal volvulus is the second most common type of colonic volvulus, accounting for 1040% of colonic volvulus. Transverse ct image a and coronal ct reformation b demonstrate a markedly dilated cecum c located in the midline and left lower. An 11yearold female child presented with abdominal pain, vomiting and constipation.
Sigmoid and cecal volvulus typically occurs between the ages of 30 and 70. Cecal volvulus, volvulous, cecum learningradiology. What is the difference between sigmoid and cecal volvulus. The sigmoid colon, and less frequently, the cecum, are the common sites of volvulus in adults. Dilated cecum comes to rest in left upper quadrant. Rare case of pediatric cecal volvulus pubmed central pmc. Cecal bascule is another variant of cecal volvulus and is associated with upward and anterior folding of ascending colon and this variant is responsible for about 10% of cases of cecal volvulus. An awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses. Cecal volvulus is the rotation or torsion of a flexible cecum and ascending colon, frequently progressing to bowel obstruction, ischemia, necrosis, and perforation unless promptly treated 1. In the upper photo, the white arrows point to the region of the twist in the cecum c itself. Cecal volvulus in an elderly woman with abdominal pain.
An incomplete midgut rotation is a predisposing factor. Cecal volvulus describes torsion of the cecum around its mesentery which often results in obstruction. Dilated loop in luq is cecum which has twisted on itself. A volvulus is a rotational twist of the colon or small bowel on its own axis, which eventually will lead to ischemia and necrosis of the bowel by impairing arterial inflow and venous outflow. Cecal volvulus accounts for 10% of all intestinal volvuluses, and generally occur in somewhat younger patients than with a sigmoid volvulus, most being 3060 years old. Demonstrated in this case is marked proximal bowel dilatation up to 10 cm with increase risk of bowel perforation and fecal peritonitis. It occurs with a specific acute onset abdominal pain associated to nausea and vomiting, so that it often poses a diagnostic challenge for the clinician who needs radiological consultation for further evaluation. Diagnosis is difficult and, if delayed, the results may be intestinal ischemia, perforation, sepsis, and.
They include malrotation in an asymptomatic patient, acute midgut volvulus, chronic midgut volvulus, acute duodenal obstruction secondary to bands, chronic duodenal obstruction, reverse rotation with colonic obstruction behind superior mesenteric vessels, internal hernias right and left mesocolic hernias and cecal. The whirlpool sign also known as the whirl sign is seen when a structure twist on itself. Rates of volvulus in the united states are about 23 per 100,000 people per year. Cecal volvulus is a very rare cause of large bowel obstruction lbo that develops when a part of the bowel twists around the mesentery. This article is based on a presentation given by jay heiken in 2006. Cecal bascule radiology, medical studies, study materials. Diagnosing midgut volvulus by ultrasound is usually straightforward. Cecal volvulus risks, symptoms and leading causes treato. Nov 16, 2016 cecum is distended and lumen narrowed by medial folding and displacement, without a twist imaging radiography. If untreated, cecal volvulus can progress to bowel ischemia, necrosis, or perforation. Cecal volvulus, one of the manifestations of intestinal malrotation and malfixation anomalies, is very uncommon in children.
The clinical manifestations, diagnosis, and management of cecal volvulus are discussed here. Sigmoid volvulus vs cecal volvulus 1 a volvulus always extends away from the area of bowel twist. There are many anomalies of intestinal rotation and fixation. Scout and coronal computed tomography cecal volvulus computerized tomography cecal volvulus sigmoid volvulus. The treatment for the two entities is identical and includes laparatomy and. The small bowel is involved in approximately 80 percent of cases of mecha. Volvulus is defined as the twisting of a loop of bowel on its mesentery and is one of the most common causes of intestinal obstruction. In children, cecal volvulus is more common compared with volvuli occurring in the. Sigmoid volvulus cecal volvulus sigmoid volvulus can only move upwards and usually goes to the right upper quadrant. Bowel obstruction occurs when the normal flow of intraluminal contents is interrupted. The caecum is grossly dilated and is not located in the rif which is occupied by small bowel.
Learn about cecal volvulus from patients first hand experiences and trusted online health resources, including common treatments and medications. Cecal volvulus is a malrotational abnormality of the intestine that causes obstruction. Reducing unnecessary and duplicate ordering for ovum and parasite examinations and clostridium difficile pcr in immunocompromised patients by using an alert at the. The caecum is most frequently a retroperitoneal structure, and therefore not susceptible to twisting. This website is intended for pathologists and laboratory personnel, who understand that medical information is imperfect and must be interpreted using reasonable medical judgment. Department of radiology, chaim sheba medical center, israel. Torsion results in narrowing of the lumen at the point of rotation and compromise of the vessels that supply the torted gut. Image result for cecal volvulus vs sigmoid volvulus. We present the case of a 58yearold female who presented to our surgical department with symptoms of intestinal obstruction. Please practice handwashing and social distancing, and check out our resources for adapting to. Cecal volvulus consists of a bowel twist involving the cecum, the ascending colon and sometimes the terminal ileum, often resulting in a closedloop obstruction.
Complications of cecal volvulus include closedloop bowel obstruction and vascular compromise, which can lead to gangrene, perforation, and death 2. It is an uncommon entity, with a relatively low incidence, causing. Volvulus of the cecum is a torsion of the bowel around its own mesentery that often results in a closedloop obstruction. Volvulus of the gastrointestinal tract, a clinically relevant cause of acute or recurring abdominal pain in adults, remains a diagnostic dilemma for radiologists in a large number of cases. The sonographer follows this vessel from its origin in the transverse plane, continuing as caudad as possible, at least past the branches that supply the. If unrecognised, it can result in bowel perforation and fecal. A cecal bascule is when the cecum folds superiorly onto the ascending colon.
Surgical treatment of cecal volvulus clinics in surgery. The ascending colon is normally fixed and retroperitoneal. This process is experimental and the keywords may be updated as the learning algorithm improves. If improperly attached, they can move and become twisted. If unrecognised, it can result in bowel perforation and fecal peritonitis. Most of the cecal volvulus reports are from asia, and the disease. Following obstructing carcinoma and inflammatory stricture. Cecal volvulus has been associated with obstructing lesions of the left colon from carcinoma or diverticulitis. In six of the twentyfour patients in the present series cecal volvulus developed while the patients were hospitalized for treatment of other disease.
Learningradiology cecal, volvulus, cecum, volvulous. Volvulus of the cecum and ascending colon is not as rare as is generally assumed. Sigmoid volvulus is differentiated from a cecal volvulus by its ahaustral wall and the lower end pointing to the pelvis. Vglllme126,aliil1l111l cecal volvulus six of twelve cases of cecal volvulus there was an associated obstructing lesion of the distal colon. Identifying the sma is the necessary first step, since midgut volvulus is centered around the superior mesenteric artery. It occurs most frequently in africa, the middle east, and india. Radiographic findings and clinical factors in dogs with. In patients with uncomplicated cecal volvulus, surgical options include cecopexy, which has a low rate of morbidity 08% and volvulus recurrence. Jul 01, 2010 cecal volvulus may occur if there is an additional insult such as scarring, adhesions, or an abdominal mass that serves as a fulcrum for rotation.
More commonly seen in people ages 30 to 60, cecal volvulus may be caused by abdominal adhesions, severe. Volvulus of the cecum is very uncommon in children. It occurs with aspecific acute onset abdominal pain associated to nausea and vomiting, so that it often poses a diagnostic challenge for the clinician who needs radiological consultation for further evaluation. In 1859, gay published his observations in an article entitled fatal obstruction from twisting of the mesocolon.
Cardiac radiology genitourinary radiology learning radiology. Sigmoid and cecal volvulus sigmoid volvulus it represents 6075% of colon volvulus cases, usually this is presented as a nursing home or debilitated elderly patient presenting to the er with constipation, abdominal distention and generalized abdominal pain. That is, the formation of a large dilated caecal pole head, with one or two further segments body and tail. Through his work on cadavers, he observed that insertion of a rectal tube detorsed sigmoid volvulus, which led him to propose that all patients with sigmoid volvulus have a rectal tube inserted 2. Apr 8, 2018 image result for cecal volvulus vs sigmoid volvulus stay safe and healthy. The volvulus is associated with intestinal obstruction and tissue infarction that may lead to tissue gangrene and death. Limited literature is available on this subject and therefore diagnostic delay can occur. However, in up to 20% of individuals there is congenital incomplete peritoneal covering of the caecum with formation of a mobile caecum on a mesentery, such that it no longer lies in the right iliac fossa. In contrast to the more common forms of volvulus, there is no axial twisting component 4 a cecal bascule may occur in the setting of a large and mobile cecum and can result in closed obstruction involving the cecal pole and appendix.
Jan 23, 2018 based on the literature, it is unclear if torsion or volvulus of the colon occurred separately or in conjunction with each other in the cases reported, and these terms have been used interchangeably. A cecal bascule may occur in the setting of a large and mobile cecum and can result in closed obstruction involving the cecal pole and appendix. The etiology and treatment and factors affecting mortality are discussed. Small bowel torsion during volvulus occurs around the dorsal mesentery. Cecal volvulus is a quite rare pathologic condition and therefore sometimes misdiagnosed, but is indeed more common than thought.