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Okay, so let's talk about cecal volvulus.

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This beautiful cartoon image shows

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the cecal volvulus perfectly.

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The cecum should be in the right lower quadrant,

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but in this case it is towards, around, and

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has extended into the left upper quadrant.

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In our patient, this is actually

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the scout image from our patient.

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You can see that this is just a classic enlarged

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cecum located in the midline of the abdomen, instead

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of the right lower quadrant. It is extremely dilated.

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Note that the distal colon is completely decompressed.

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At times you'll see dilated loops of small

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bowel coming up to a cecal volvulus on a KUB.

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But either way, this would be a classic appearance.

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Sometimes we refer to this as the kidney bean.

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I don't a hundred percent see that, but I'm just going to

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go with that as one of our, um, signs in radiology.

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Now on CT, you could see that whirling appearance.

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We call that the whirl sign.

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That is actually the twisting and turning.

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I always yell, oh, hold onto Toto.

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We're going off, you know, into Oz, but it's a very

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typical sign of volvulus and torsion, is this whirl sign

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in the mesentery of small bowel volvulus and cecal volvulus here.

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So who gets cecal volvulus?

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Cecal volvulus is a slightly different entity than the sigmoid

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volvulus, which we oftentimes talk about in, um, comparison.

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The cecal volvulus is a result of

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an aberration of embryogenesis.

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Oh my god.

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Embryogenesis.

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That's right.

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Lori's going to bring you back to this.

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I do enjoy embryology, and I have to say it was one of

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my favorite things in medical school, and now they only

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teach it for like two days, which makes me very sad.

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But we may remember that the bowel herniates

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during, uh, certain stages of embryogenesis

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and then comes back into the colon and rotates

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in the periphery of the abdomen.

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So in normal rotation, the cecum will end up in the

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right lower quadrant, adhesed to the retroperitoneum.

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But there's a lot of variability of

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embryogenesis, and I like to tell my

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medical students every morning that if the

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first 12 weeks of folding went well for you,

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you're already winning.

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Like let's bring down the anxiety in life.

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Like those were some important weeks,

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and if it went well, you're pretty good.

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Um, but there is some small imperfections

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and some small variability which can occur.

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So you could be somebody who has an incomplete rotation

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of the colon and has a right upper quadrant colon.

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We frequently will see appendicitis causing

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right upper quadrant pain, which is

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unique, but you have other options as well

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where the cecum not only rotates into the

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right lower quadrant, but over-rotates and

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ends up going down even into the pelvis, and

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the cecum itself will be on its own mesentery.

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Instead of fixing to the posterior

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retroperitoneal wall, that cecum will have its

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own mesentery and it will have the ability

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to kind of rotate and move in the abdomen.

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This tends to be more common in women

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than men, though we do see it in men.

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Frequently, it'll be one of those causes where you see

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that cecum TI or appendix way deep down in the pelvis.

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So once you have that anatomic variant, you

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have the opportunity for that variant to twist

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and turn, as in this case, the cecal volvulus.

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So cecal volvulus tends to be in a younger population,

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somebody with a congenital variation of the mesenterized

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cecum and will present with this whirl sign and the cecum

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being outside of the right lower quadrant, usually

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in the midline with a very distended cecum, which

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may have the appearance of a kidney bean on KUB.