title: Clinics in diagnostic imaging (171). Caecal volvulus with underlying intestinal malrotation.
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.
authors.affiliation: Diagnostic Radiology Programme, SingHealth Residency, Singapore.
authors.forename: Su Kai Gideon
authors.initials: SK
authors.lastname: Ooi
authors.affiliation: Department of Diagnostic Radiology, Changi General Hospital, Singapore.
authors.forename: Tien Jin
authors.initials: TJ
authors.lastname: Tan
authors.affiliation: Department of General Surgery, Changi General Hospital, Singapore.
authors.forename: James Chi Yong
authors.initials: JC
authors.lastname: Ngu
mesh_terms: D015746:Abdominal Pain; D001062:Appendectomy; D002681:China; D002763:Cholecystectomy; D003287:Contrast Media; D004635:Emergency Medicine; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000601:surgery*; D045822:Intestinal Volvulus / Q000175:diagnosis / Q000473:pathology; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media
keywords: abdominal radiography; computed tomography; intestinal obstruction; malrotation; volvulus