Volvulus of the cecum is a torsion of the bowel around its own mesentery that often results in a closed-loop obstruction. Cecal volvulus can only occur in the small percentage (11-25%) of the populationwho have a developmental failure of peritoneal fixation, allowing the proximal colon to be free and mobile [1]. The second requirement is restriction of the bowel at a fixed point within the abdomen that serves as a fulcrum for rotation, such as an adhesion, abdominal mass, or scarring from calcified lymph nodes [2].
Recognition of the CT signs of cecal volvulus is critical because the findings at clinical examination are often vague and because CT is usually the imaging technique of choice for patients presenting with acute abdominal pain [3]. Furthermore, diagnosis may be difficult: The images on the patient�s abdominal radiographs could be obscured if the closed loop is filled with fluid, oriented in an anteroposterior plane, or overlain by loops of air-distended bowel [4]. CT reveals the presence and location of the volvulus and gives the added benefit of allowing early identification of potentially fatal complications, such as ischemia and perforation. Three-dimensional (3D) reconstructions may furthur improve diagnostic capabilities by allowing visualization of the entire bowel in a single image. This pictorial essay uses schematic diagrams and cases of representative patients to describe the CT appearance of cecal volvulus and the diagnostic benefit of 3D imaging.