Clinics in diagnostic imaging (171). Caecal volvulus with underlying intestinal malrotation.
- Author:
Su Kai Gideon OOI
1
;
Tien Jin TAN
2
;
James Chi Yong NGU
3
Author Information
- Publication Type:Case Reports
- Keywords: abdominal radiography; computed tomography; intestinal obstruction; malrotation; volvulus
- MeSH: Abdominal Pain; Appendectomy; China; Cholecystectomy; Contrast Media; Emergency Medicine; Female; Humans; Intestinal Obstruction; diagnostic imaging; surgery; Intestinal Volvulus; diagnosis; pathology; Middle Aged; Tomography, X-Ray Computed
- From:Singapore medical journal 2016;57(11):598-602
- CountrySingapore
- Language:English
- Abstract: A 46-year-old Chinese woman with a history of cholecystectomy and appendicectomy presented to the emergency department with symptoms of intestinal obstruction. Physical examination revealed central abdominal tenderness but no clinical features of peritonism. Plain radiography of the abdomen revealed a grossly distended large bowel loop with the long axis extending from the right lower abdomen toward the epigastrium, and an intraluminal air-fluid level. These findings were suspicious for an acute caecal volvulus, which was confirmed on subsequent contrast-enhanced computed tomography (CT) of the abdomen and pelvis. CT demonstrated an abnormal positional relationship between the superior mesenteric vein and artery, indicative of an underlying intestinal malrotation. This case highlights the utility of preoperative imaging in establishing the diagnosis of an uncommon cause of bowel obstruction. It also shows the importance of recognising the characteristic imaging features early, so as to ensure appropriate and expedient management, thus reducing patient morbidity arising from complications.
