Case Report
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World J Radiol. Oct 28, 2012; 4(10): 439-442
Published online Oct 28, 2012. doi: 10.4329/wjr.v4.i10.439
Volvulus of the ascending colon in a non-rotated midgut: Plain film and MDCT findings
Luigi Camera, Milena Calabrese, Pier Paolo Mainenti, Stefania Masone, Walter Del Vecchio, Giovanni Persico, Marco Salvatore
Luigi Camera, Milena Calabrese, Marco Salvatore, Department of Radiology, University “Federico II”, 80131 Naples, Italy
Pier Paolo Mainenti, Walter Del Vecchio, Institute of Biostructures and Bioimages, National Research Council (CNR), 80131 Naples, Italy
Stefania Masone, Giovanni Persico, Department of General and Geriatric Surgery, University “Federico II”, 80131 Naples, Italy
Author contributions: Camera L was responsible for case observation and manuscript revision; Calabrese M was responsible for manuscript preparation; Mainenti PP and Del Vecchio W were responsible for literature research; Masone S and Persico G performed laparotomy; Salvatore M was responsible for manuscript editing.
Correspondence to: Luigi Camera, MD, Department of Radiology, University “Federico II”, Via S. Pansini 5, 80131 Naples, Italy.
Telephone: +39-81-7463560 Fax: +39-81-5457081
Received: September 25, 2011
Revised: October 11, 2011
Accepted: January 4, 2012
Published online: October 28, 2012

Colonic volvulus is a relatively uncommon cause of large bowel obstruction usually involving mobile, intra-peritoneal, colonic segments. Congenital or acquired anatomic variation may be associated with an increased risk of colonic volvulus which can occasionally involve retro-peritoneal segments. We report a case of 54-year-old female who presented to our Institution to perform a plain abdominal film series for acute onset of cramping abdominal pain. Both the upright and supine films showed signs of acute colonic obstruction which was thought to be due to an internal hernia of the transverse colon into the lesser sac. The patient was therefore submitted to a multi-detector contrast-enhanced computed tomography (CT). CT findings were initially thought to be consistent with the presumed diagnosis of internal hernia but further evaluation and coronal reformatting clearly depicted the presence of a colonic volvulus possibly resulting from a retro-gastric colon. At surgery, a volvulus of the ascending colon was found and a right hemi-colectomy had to be performed. However, a non rotated midgut with a right-sided duodeno-jejunal flexure and a left sided colon was also found at laparotomy and overlooked in the pre-operative CT. Retrospective evaluation of CT images was therefore performed and a number of CT signs of intestinal malrotation could be identified.

Keywords: Colonic volvulus, Intestinal malrotation, Abdominal plain film, Multi-detector computed tomography, Large bowel obstruction