Cecal Bascule With Concurrent Acute Appendicitis

Ben E. Eggleston, MD; Rizwana Afzal, MD

Disclosures

Appl Radiol. 2011;40(11):28-30. 

In This Article

Imaging Findings

A supine abdominal radiograph with distended bowel loops in the right flank and epigastric region. Lateral CT/scout shows distended large bowel with fluid levels (note haustra) (Figure 2). Scanogram shows distended bowel with haustra oriented vertically at the epigastrium, and measuring > 9 cm in diameter. Note stomach with feeding tube in left upper quadrant (LUQ). Scanogram shows distended bowel with haustra oriented vertically at the epigastrium, and measuring > 9 cm in diameter (Figure 3). Note stomach with feeding tube in LUQ. CT image with IV contrast shows gaseous distended cecum anterior to collapsed stomach containing a feeding tube (residual oral contrast after multiple emesis) (Figure 4). A 1-cm diameter appendix interposed between the malpositioned, distended cecum anteriorly and the displaced terminal ileum posteriorly (Figure 5). The curvilinear course of superior mesenteric vein (SMV) tributary veins is also noted. This image captures the ascending colon coursing anteriorly to meet the air-filled cecum (Figure 6). However, the classic bowel tapering ("beak") at the point of twist is not well seen. Note the characteristic, malpositioned, and fluid-filled ileum to the right of the ascending colon. A CT coronal reconstruction image (Figure 7) shows malpositioned, distended proximal ascending colon and cecum anteriorly. A more posterior CT coronal reconstruction image (Figure 8) shows the distended cecum superiorly as well as the collapsed transverse colon inferiorly. The further posterior CT coronal reconstruction image (Figure 9) shows the nasogastric (NG) tube in the collapsed stomach. Moreover, a 11-mm diameter appendix is seen curling toward the midline in the right upper quadrant (RUQ).

Figure 2.

Lateral computed tomography (CT) scanogram/scout shows distended large bowel with fluid levels (note haustra).

Figure 3.

Scanogram shows distended bowel with haustra oriented vertically at the epigastrium, and measuring greater than 9 cm diameter. Note stomach with feeding tube in LUQ.

Figure 4.

Axial-CT image with IV contrast shows gaseous distended cecum anterior to collapsed stomach containing a feeding tube (residual oral contrast after multiple emesis).

Figure 5.

A 1-cm diameter appendix appears interposed between the malpositioned, distended cecum anteriorly and the displaced terminal ileum posteriorly. The curvilinear course of SMV tributary veins is also noted.

Figure 6.

Level of fold/twist. This image captures the ascending colon coursing anteriorly to meet the air-filled cecum. However, the classic bowel tapering ("beak") at the point of twist is not well seen. Note the characteristic, malpositioned, and fluid-filled ileum to the right of the ascending colon.

Figure 7.

CT-coronal reconstruction image shows malpositioned, distended proximal ascending colon and cecum anteriorly.

Figure 8.

More posterior CT-coronal reconstruction image shows the distended cecum superiorly as well as the collapsed transverse colon inferiorly. Also, note the appendix origin.

Figure 9.

Further posterior CT-coronal reconstruction image shows the NG tube in the collapsed stomach. Moreover an 11-mm diameter appendix is seen curling toward the midline in the RUQ.

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