A 56-year-old female presented with acute severe abdominal pain and nausea with a distended right abdomen. Imaging showed cecal volvulus, identified by a dilated cecum greater than 9cm that had rotated into the mid or left upper abdomen. She was started on IV fluids, made NPO, and required surgical consultation for definitive management due to the high risk of perforation or ischemia with cecal volvulus.

2.  56 year old female with T 98.6 P 100 R 16 BP 120/80
Gen: normal appearing female who
acute onset of severe appears to be in pain
abdominal pain and HEENT: PERRLA, oropharynx
clear, NC/AT head
nausea. Also complaining CV: RRR no m/r/g
of distended right sided Pulm: CTAB
Abd: distended in Right abd > Left
abdomen. She has no abdomen, TTP diffusely, greater in
medical history, otherwise Right abdomen,
Ext: 2+ pulses, no c/c/e
healthy female.

4. •Maintain Haustral Markings
•Can usually see haustra
•Arise in RLQ and point
toward LUQ
•Kidney-shaped distended
cecum
•Greater than 9cm
•Caput cecum usually
rotates into mid abdomen
or left upper quadrant
•Air-filled appendix
•Little gas in rest of colon

5.  IV Fluid Resuscitation
 NPO
 Only 10-15% can be detorsed with Colonoscopy
 Surgical Consultation for definitive management
 Broad Spectrum Antibiotics if signs of
peritonitis, ischemic bowel, or sepsis

6.  Misnomer: It does not just involve the cecum. the entire
ascending colon lacks normal fusion of mesentery to
posterior abdominal wall and you get cecocolonic twisting
around the ileocolic vascular pedicle.
 Depending on the initial position and the length of mobile
right colon, the cecum can be found anywhere in the
abdomen but often found in LUQ.
 >9 cm is considered a dilated cecum. >12cm concern for
impending perforation.
 Conservative management (No surgery) approaches 100%
mortality rate; vascular compromise occurs early.

7. Cecal Volvulus Point of torsion may be
identified by an area of cone
like narrowing, outlined by gas.

8.  http://radiopaedia.org/articles/caecal_volvulus
 http://www.learningradiology.com/archives05/COW%
20152-Cecal%20Volvulus/cecalvolvuluscorrect.htm
 Schwartz, David. Emergency Radiology. 2000. pg 527-
529.
 Tintanelli’s Emergency Medicine: A Comprehensive
Study Guide. Chapter 79 Intestinal Obstruction