Cecal Volvulus X-ray: Spotting the Twist & Obstruction

Cecal Volvulus X-ray:

Abdominal X-ray showing cecal volvulus with a distended and displaced cecum, indicating bowel obstruction.
Cecal Volvulus: Radiographic evidence of a twisted cecum leading to bowel obstruction.

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

ProcedureWhen UsedRecurrence Risk
Right hemicolectomy (removal of cecum + colon)Most cases<5%
Cecopexy (stitching cecum in place)Only if bowel is healthyUp to 40%
Cecostomy (drainage tube in cecum)High-risk patientsModerate

Note: If bowel is dead (ischemic), resection is mandatory to prevent life-threatening infection.


Key Differences from Sigmoid Volvulus

FeatureCecal VolvulusSigmoid Volvulus
LocationRight colonLeft colon
Fixable without surgery?RarelyOften
Classic X-rayLeft upper quadrant cecum“Coffee bean” shape
Common Age30-60 yearsElderly

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:

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