Cecal volvulus diagnosed on CT in two distinct clinical settings.

CASE 1 A 55-year-old white female presented to the emergency department in moderate distress with sudden onset severe lower abdominal pain, progressive over twelve hours with a “twisting” character that worsened with movement. She denied nausea or vomiting and reported having a normal bowel movement just prior to symptom onset. Her past medical history included a distant history of breast cancer but was otherwise negative. Her vital signs were normal. Her abdomen was mildly tender at the lower quadrants, as well as mildly distended and tympanic without peritoneal signs. Bimanual exam was normal. Laboratory analysis was non-revealing. A contrast-enhanced CT of the abdomen and pelvis was obtained. The CT topogram (Figure 1) revealed a loop of dilated, stool-filled bowel in the mid abdomen, confirmed to represent dilated cecum on coronal CT imaging (Figure 2). Axial CT imaging (Figure 3) demonstrated a decompressed ascending colon with transition to cecal dilation at the level of a CT whirl sign. The patient proceeded to emergent exploratory laparotomy where a torsed and markedly dilated cecum was encountered. A right hemicolectomy with functional side-to-side end iliocolocstomy was performed. The patient experienced an uncomplicated post-operative course and was discharged on day 5 following the procedure. Figure 1. CT topogram demonstrates a dilated stool filled bowel loop in the mid abdomen (arrow) with preserved haustral markings (arrowhead).