What is the diagnosis?
Our patient was transferred in with the diagnosis of sigmoid volvulus on CT. GI spent 2.5 hours trying to decompress the sigmoid before it was recognized that she had a cecal volvulus and needed surgery. What is the difference between the two?
A cecal volvulus is caused by rotation of the cecum usually to the LUQ with 1-3 percent of large bowel obstructions caused by a cecal volvulus. The rotation can also occur above the cecal valve causing a torsion in the ascending colon. There is a defective peritoneal fixation of the ascending colon in 10% of the population putting them at risk for malrotation. People with obstructive lesions in the L colon are also at risk for cecal volvulus. The “ whirl sign” can be seen in this patient; the rotated mesentery in the center of the patients xray.
Sigmoid volvulus accounts for 2-50% of large bowel obstruction with the higher number found in Eastern countries. It usually affects adults and is more common in males. The sigmoid rotates on itself and the loop is seen in the mid abdomen or the RUQ forming the “coffee bean” sign. People with chronic constipation may be more at risk. Sigmoid volvulus can often be detorsed but surgical resection is most commonly recommended at a later date. A barium study can differentiate the two types of volvulus.
Our patient was taken to the OR and had a dead right colon from her cecal volvulus. This was resected and she did well.
Frank AJk, Goffner LB, Fruauff AA. Cecal volvulus: the CT whirl sign. Abdom Imaging 1993.18(3):288-9.
Rosenblat J, Rozenblit AM, Wolf E, DuBrowRA, et al.indings of cecal volvulus at CT. Radiology. 2010 Jul. 256:169-75.
Yoo SJ, Park KW, Cho SU. Definitive diagnosis of intestinal volvulus in utero. Ultrasound Obstet Gynecol. 1999 Mar.13(3).
Atamanalp, S Sigmoid Volvulus 2010 Eurasian J ed 42(3):142-147