Pictorial Essay
Cecal Volvulus: Retrospective Analysis of CT Evaluation in the Emergency Teleradiology Setting with a Pictorial Review of the Salient Features
Rao P1*, Kalyanpur A2 and Menon A3
1Senior Scientific Officer, Image Core Lab, Whitefield, Bangalore, India
2Chief Radiologist, Teleradiology Solutions, Whitefield, Bangalore, India
3Consultant Radiologist, Image Core Lab, Whitefield, Bangalore, India
2Chief Radiologist, Teleradiology Solutions, Whitefield, Bangalore, India
3Consultant Radiologist, Image Core Lab, Whitefield, Bangalore, India
*Corresponding author:Pallavi Rao, Senior Scientific Officer, Image Core Lab, Whitefield, Bangalore, India. E-mail Id:dr.pallavirao.radiology@gmail.com
Copyright: © 2024Rao P, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article Information:Submission: 21/03/2024; Accepted: 26/04/2024; Published: 30/04/2024
Abstract
Cecal volvulus is a torsion of the cecum around its own mesentery and accounts for 30% of all colonic volvulus. It is predisposed to by a developmental failure of peritoneal fixation, allowing the proximal colon to be free and mobile.
Materials and Methods:This study is a retrospective evaluation of 80 contrast computed tomography (CT) abdomen and pelvis studies acquired in an emergency teleradiology setting with a diagnosis of Cecal volvulus on the communicated report. The study images selected using keyword search were analysed by four expert radiologists to document salient imaging features, unusual findings, and complications in Cecal volvulus on CT abdomen and pelvis images. The results were analysed to compile a pictorial review along with a statistical compilation.
Results:Our study demonstrated that a dilated and displaced cecum with a whirl sign was the most common imaging findings seen in 97.5% and 95% of the patients diagnosed with Cecal volvulus. Cecal wall thickening was seen in 11.2% of the studies, associated small bowel obstruction was seen in 32.5% of the studies and a beak sign was demonstrated in 48.7% of the studies. Mesenteric oedema was seen in 20% of the patients, while uncommon findings (<5%) included pneumatosis, bowel perforation, and intraluminal haemorrhage.
Conclusion:Cecal volvulus is an acute abdominal emergency requiring expeditious diagnosis. Identification of an abnormally located dilated cecum with a whirl sign on CT is helpful to alert the referring physician of this entity. Early diagnosis of Cecal Volvulus can prevent the occurrence of bowel strangulation, gangrene, perforation, and peritonitis.
Materials and Methods:This study is a retrospective evaluation of 80 contrast computed tomography (CT) abdomen and pelvis studies acquired in an emergency teleradiology setting with a diagnosis of Cecal volvulus on the communicated report. The study images selected using keyword search were analysed by four expert radiologists to document salient imaging features, unusual findings, and complications in Cecal volvulus on CT abdomen and pelvis images. The results were analysed to compile a pictorial review along with a statistical compilation.
Results:Our study demonstrated that a dilated and displaced cecum with a whirl sign was the most common imaging findings seen in 97.5% and 95% of the patients diagnosed with Cecal volvulus. Cecal wall thickening was seen in 11.2% of the studies, associated small bowel obstruction was seen in 32.5% of the studies and a beak sign was demonstrated in 48.7% of the studies. Mesenteric oedema was seen in 20% of the patients, while uncommon findings (<5%) included pneumatosis, bowel perforation, and intraluminal haemorrhage.
Conclusion:Cecal volvulus is an acute abdominal emergency requiring expeditious diagnosis. Identification of an abnormally located dilated cecum with a whirl sign on CT is helpful to alert the referring physician of this entity. Early diagnosis of Cecal Volvulus can prevent the occurrence of bowel strangulation, gangrene, perforation, and peritonitis.
Keywords:Cecal Volvulus; Whirl Sign; Cecal Dilatation