Colonic volvulus Quiz: Ace Your Exams

A 72-year-old man presents to the emergency department with a 10-hour history of abdominal pain and a five-day history of constipation. He reports prior episodes of constipation that resolved with increasing his fluid and fiber intake. He does not have hematochezia or unintentional weight loss. He has a history of hypercholesterolemia which is well-controlled with atorvastatin. Temperature is 37.2°C (99.1°F), pulse is 87/min, and blood pressure is 123/82 mmHg. Abdominal examination reveals a distended tympanic abdomen with diffuse rebound tenderness with guarding and hyperactive bowel sounds. No obstructing masses are detected on the digital rectal exam. Based on this patient’s presentation and findings, colonic volvulus is strongly suspected. Which of the following findings would support a diagnosis of cecal volvulus as opposed to sigmoid volvulus?