Colonic tumour precipitating caecal volvulus within a diaphragmatic hernia

Figure 1 Plain radiographic images of the patient upon emergency admission. A: Erect chest radiograph upon admission demonstrated that the patient had a collapsed left lung and elevated left hemidiaphragm with a large viscous identified under the left hemidiaphragm; B: Plain abdominal radiograph on admission revealed a gas filled viscous within the left upper quadrant consistent with caecal volvulus.

Figure 2 Computed tomography findings on admission. A sagittal computed tomography scan with intravenous contrast clearly demonstrated that the caecum had herniated thorough a diaphragmatic hernia and was the cause of the intestinal obstruction.

Figure 3 Operative findings at laparotomy. Following reduction of the caecal bascule from the diaphragmatic hernia the caecum demonstrated multiple serosal defects that necessitated right hemicolectomy.