Cecal volvulus: CT findings and correlation with pathophysiology

The purpose of this study is to report the computed tomography (CT) features of cecal volvulus and to determine the accuracy of CT in distinguishing the three pathophysiological types of cecal volvulus. The CT studies of ten patients with surgically confirmed cecal volvulus were reviewed. For each patient, CT findings were looked for and recorded. The precise location of the cecum within the abdomen, the presence of an ileocecal twist, and the clockwise or counterclockwise direction of the whirl sign were specifically analyzed. All these results were confronted to the surgical diagnosis retrospectively correlated with the three types of cecal volvulus. According to our classification based on the analysis of the location of the cecum within the abdomen and the presence or the absence of a whirl sign on CT scans, the cecal volvulus was defined as the axial torsion type in four (40%) patients, loop type in four (40%) patients, and cecal bascule type in two (20%). For each patient, the result was in full accordance with the type of cecal volvulus diagnosed at surgery. CT is not only a valuable diagnostic technique in diagnosing cecal volvulus and its complications, but it is also useful in distinguishing the three pathophysiological types of cecal volvulus.