Caecal volvulus is an uncommon condition and represents only 10% of all colonic volvulus. The mechanism is due to hypermobile cecum twisting around it is own mesentery. A 40-year-old female who was previously fit and well-attended hospital with 2 days history of intermittent abdominal pain, mild distention and constipation. X-rays showed twisted and dilated loops of bowel with right hepato-diaphragmatic bowel loops entrapment. A computed tomography scan was the only confirmatory test of caecal volvulus with intermittent bowel symptoms. Emergency laparotomy revealed complex intraoperative bowel loops malrotation with congenital bands and abnormal position of Duodeno-Jejenal flexure. Open right hemicolectomy was the operation of choice for this complex case. Caecal volvulus must be considered as one of the important differential diagnosis of acute abdomen during initial assessment of patients with intermittent bowel symptoms in emergency department in order to avoid any therapeutic delay.
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