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A 50 years old woman presented to the hospital with sudden acute severe abdominal pain and distension of about 24 hours associated with vomiting and no flatus. In her clinical history, she has had a hysterectomy for myomatosis. She denied other medical problems. On physical examination, we found altered vital signs and hemodynamic instability. Abdominal examination noticed diffuse abdominal distension, tympanic sound, and positive Blumberg sign. Laboratory studies showed WBC 20 cell/mm3 and elevated PCR. Rx abdomen showed intestinal distension suggestive of Sigma volvulus. In the scout, CT scan showed coffee bean sign (Figure 1), bird beak sign (Figure 2) and whirl sign (Figure 3). So we performed an urgent colonoscopy to view mucosa and to possible sigma volvulus untwisting. Colonoscopy showed normal mucosa and no sigma volvulus. The patient was under went an urgent laparotomy with findings at the operation showing axial rotation of the caecum and terminal ileum with ischemia extended from the terminal ileum to right colon flexure (Figure 4). We performed a classical right colectomy with ileocecal mechanic side to side anastomosis for good patient status. The patient was discharged in seven postoperative days with no medical problems.

Caecum Volvulus: A Rare Diagnosis for Surgeon. Case Report and Key Points Review