0:00

Okay, here we go.

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Another contrast enhanced CT scan in somebody

0:04

who has abdominal pain, nausea, and vomiting.

0:06

Already on this first axial image of

0:08

the upper abdomen, we can see a little bit

0:10

of ascites, so that's not a great sign.

0:12

Um, we're already considering this patient is not

0:15

feeling so well. Here is the liver that enhances pretty

0:18

homogeneously, and the spleen is homogeneous as well.

0:21

The pancreas looks okay.

0:24

When we come down, we see that there's

0:25

this large viscus in the midline.

0:27

Is that the stomach?

0:28

No, the stomach is up here and has actual

0:31

oral contrast within it, so we're going to have

0:33

to figure out what this is, but maybe we

0:35

won't really want to do that on axial images.

0:37

But there's definitely, um, some trouble brewing in

0:40

the right upper quadrant over to midline as well.

0:43

Noticing that the colon on the descending

0:46

side is very decompressed all the way

0:48

down into the pelvis to the rectum.

0:50

Let's go on coronal.

0:51

I think that that's going to be our best view.

0:53

I always say.

0:54

Colon and kidneys on coronal.

0:57

That's how I always do my

0:58

interrogation of those two organs.

1:00

The kidneys, you can see, you can just determine if

1:02

they enhance symmetrically so nicely on the coronals.

1:05

So let's come to the front here and

1:07

notice that there's very dilated viscus.

1:09

That's not perforated.

1:10

Remember what I told you is the 3 6 9 rule.

1:13

Well, this is the cecum, and it is very dilated.

1:17

Really only the cecum could get

1:18

this big and not, you know, blow up.

1:20

Uh, here we have the ileocecal valve, and

1:22

as we come through, we're going to see a.

1:24

Twisting torsion, whirling of the cecum, which

1:29

is located now in the midline, which is abnormal.

1:31

It should be in the right lower quadrant.

1:33

And then after the whirling, swirling, and or

1:36

tornado in the right upper quadrant here, we're

1:39

going to see that the colon now decompresses.

1:42

So this whirling swirling of the cecum is consistent

1:46

with a cecal volvulus causing obstruction, and

1:50

that is the cause of this patient's abdominal pain.