CT of the abdomen in a patient with acute abdominal pain shows a distended cecum measuring 14 cm with a 'whirl sign' of mesenteric vessels and 'coffee bean sign'. The cecum has migrated to the left upper quadrant. What is the diagnosis?

• A Cecal volvulus — cecum twisted and migrated to LUQ with right colon decompressed ✓
• B Sigmoid volvulus — typically sigmoid loop in LUQ
• C Transverse colon volvulus — rare, transverse loop displaced
• D Ogilvie syndrome — pseudo-obstruction, no whirl sign

Explanation

Cecal volvulus occurs when a hypermobile cecum twists on its mesentery, producing a massively distended cecum that migrates away from the right iliac fossa (classically to the left upper quadrant or epigastrium). CT shows the whirl sign (twisted mesenteric vessels), the 'coffee bean sign' (two limbs of distended cecum), and absence of haustra beyond the point of torsion, with a decompressed right colon distally. Sigmoid volvulus shows the closed loop in the mid-abdomen/LUQ pointing toward the right shoulder, with a massively distended sigmoid with intact haustral markings. Ogilvie syndrome has no mesenteric twist/whirl sign.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.