Volvuli can occur at many points along the gastrointestinal tract, including the sigmoid colon(65%), cecum(30%), transverse colon(3%), or splenic flexure(2%).1 Cecal volvulus involves the cecum, terminal ileum, and proximal ascending colon, affecting approximately 2.8 to 7.1 per million persons annually.2 While it frequently progresses to ischemia of the bowel, a delay in diagnosis may lead to bowel infarction, perforation, sepsis, and/or death.3 The mean age of diagnosis within the US is 53 years, younger than in patients with sigmoid volvulus, which typically occurs in elderly patients.4 There are 2 types of cecal volvuli, axial volvulus and cecal bascule. Axial volvulus involves rotation of the cecum around the ileocolic mesenteric vessels, …show more content…
The diagnosis of cecal volvulus may be suggested by plain film examination, with abdominal films demonstrating a largely dilated cecum most commonly found in the epigastric area or the left upper quadrant.4 The classic description for the dilated cecum is a “coffee bean” appearance, with the concave surface directed toward the right lower quadrant. Conversely, a sigmoid volvulus typically demonstrates a “coffee bean” with the convexity toward the left lower quadrant. Care should be taken not to mistake a fluid level in early volvulus for the gastric bubble, which cannot be aspirated with tube decompression.1 The classic “coffee bean” is only demonstrated in approximately 25% of cases, typically requiring further evaluation with other imaging.3 Barium enema may be utilized, demonstrating a “bird beak” sign, indicating the gradual narrowing of the bowel lumen at the site of occlusion, with a diagnostic accuracy of 88%.2 CT is typically utilized for diagnosis, with a detection rate of 90%. Findings include a “whirl sign,” indicating an axial volvulus of the ileocolic vessels. Other signs include small bowel obstruction and/or signs of bowel ischemia (mural thickening and edema).4 A unique finding in this patient is the compression of the duodenum by the obstructed cecal loop, resulting in gastric outlet