This is a plain erect abdominal X-ray of  a 71 year old male patient who was complaining of  Colicky Abdominal pain and vomiting.There was an abdominal distension too.Identify this Xray?


ANSWER -  Caecal volvulus

A caecal volvulus occurs when there is twisting of the bowel at the caecum and resultant intestinal obstruction.
As a result of the torsion, the ileum to wrap around the ascending colon.

CLINICAL FEATURES
Patient may have Signs of Large Intestinal Obstruction-  Vomiting, Abdominal pain and Constipation
Distended Caecum can be felt as a palpable mass

INVESTIGATIONS
The classical radiological appearance of this condition is the 'comma' sign - there is a gas-filled ileum and caecum

TREATMENT
Decompression and resection
Fixing of the caecum to the posterior abdominal wall

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12 comments

  1. Anonymous Says:
  2. i think the x - ray was shown in opposite site ( "L" sign )

     
  3. Anonymous Says:
  4. large intestinal obstruction..

     
  5. Anonymous Says:
  6. Intestinal obstruction

     
  7. Anonymous Says:
  8. left large intestinal obstruction

     
  9. shameel Says:
  10. is it a volvulus? where can i find the answers to these xrays?

     
  11. Anonymous Says:
  12. Obviously this is a large bowel obstruction.
    Is this sigmoidal volvulus or caecal volvulus!!!
    How do we differentiate them?

     
  13. xydau Says:
  14. Sigmoidal Volvulus - commonest site of colonic volvulus,Plain abdominal x-ray may show a large ‘bean’ shaped loop or inverted U shaped loop of large bowel arising from pelvis,bowel loop points to RUQ
    Caecal volvulus - Plain abdominal x-ray shows a comma shaped caecal shadow in mid abdomen,bowel loop points to LUQ,Dilated cecum comes to rest in left upper quadrant
    So this is more likely to be a ceacal volvulus.

     
  15. VOLVULUS OF THE CAECUM-The gas-distended caecum
    fills the right iliac fossa, unlike
    a sigmoid volvulus, which arises in the left iliac fossa and tends to be
    directed to the right upper quadrant

     
  16. SHERIF MONIB Says:
  17. Plain abdominal x-ray showing large bowel obstruction most likley due to Sigmoid Volvulus.

     
  18. Anonymous Says:
  19. why not this is pancreatitis with sentinal loop? whats against it surgeons?

     
  20. It is a Sigmoid Valvulus.
    Twisting on its axis and is laying in the RUQ cutting off at the transverse colon. If a low rectal enima does not relive the obstruction, an urgent laprotomy is indicated.

     
  21. Anonymous Says:
  22. position of Xray is correct. Obstruction of large colon

     

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