Cecal Volvulus X-ray:
Cecal volvulus is a medical emergency that occurs when the cecum and a portion of the ascending colon twist around their mesentery. This leads to bowel obstruction and potential ischemia. Radiographically, it presents with a dilated, often displaced cecum, as seen in this abdominal X-ray. Prompt diagnosis and intervention are crucial to prevent complications.
What is Cecal Volvulus?
Cecal volvulus occurs when the right colon twists around itself, causing a dangerous bowel obstruction. Unlike sigmoid volvulus, this condition can’t typically be fixed without surgery because blood flow gets cut off quickly.
Key Facts:
- Happens when the cecum isn’t properly attached to the abdominal wall
- Most twists occur clockwise around the ileocolic blood vessels
- 10-30% of cases involve folding rather than twisting (cecal bascule)
- Most common in women aged 30-60
- Ischemia (tissue death) develops rapidly in most cases
Symptoms and Diagnosis of Cecal Volvulus
Classic Signs
- Sudden severe abdominal pain
- Nausea and vomiting
- Abdominal distension
- Initially may pass some stool/gas (partial obstruction)
- Palpable mass in 25% of cases (usually left side)
Diagnostic Imaging of Cecal Volvulus
X-ray Findings
- Kidney-shaped air-filled cecum in left upper quadrant (opposite normal position)
- “Comma-shaped” bowel loop pointing down and right
- Dilated small bowel with air-fluid levels
CT Scan (Best Test)
- Shows twisted bowel (whirl sign)
- Reveals ischemia complications
- Replacing barium enemas for diagnosis
Barium Enema (If No Ischemia)
- Shows “bird’s beak” narrowing at twist site
- No contrast reaches the cecum
Emergency Treatment of Cecal Volvulus
Why Surgery is Usually Needed
- Endoscopic detorsion rarely works (unlike sigmoid volvulus)
- Blood supply gets cut off quickly → risk of bowel death
- High recurrence rate with simple fixes
Surgical Options
| Procedure | When Used | Recurrence Risk |
|---|---|---|
| Right hemicolectomy (removal of cecum + colon) | Most cases | <5% |
| Cecopexy (stitching cecum in place) | Only if bowel is healthy | Up to 40% |
| Cecostomy (drainage tube in cecum) | High-risk patients | Moderate |
Note: If bowel is dead (ischemic), resection is mandatory to prevent life-threatening infection.
Key Differences from Sigmoid Volvulus
| Feature | Cecal Volvulus | Sigmoid Volvulus |
|---|---|---|
| Location | Right colon | Left colon |
| Fixable without surgery? | Rarely | Often |
| Classic X-ray | Left upper quadrant cecum | “Coffee bean” shape |
| Common Age | 30-60 years | Elderly |
Why Early Surgery Matters
- Delayed treatment leads to:
- Bowel perforation
- Severe infection (sepsis)
- Death in 10-40% of cases
- Best outcomes come from quick diagnosis and resection
For more medical details, see:
Have questions about abdominal emergencies? Ask below!
