Volvulus CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

The initial investigation for volvulus can be a plain x-ray without contrast, or a CT scan. CT scan is useful in diagnosing volvulus when x-ray has been unfruitful. CT can also identify the level of obstruction and determine if bowel necrosis has occurred.

CT

  • The abdominal CT should be performed when the patient presents with symptoms of abdominal pain, distension, constipation/obstipation and nausea.[1][2]
  • A CT scan can determine obstruction level, rule out other causes of abdominal pain and obstruction, and when pathology is not clear with a plain x-ray.
    • The following result of abdominal CT is indicative of volvulus:
      • Sigmoid, cecal, ileal volvulus:
        • Whirl pattern signifying a dilated bowel
        • Bird beak appearance of afferent and efferent colonic segments
        • Absence of rectal gas
        • Separation of the sigmoid walls by adjacent mesenteric fat (split wall sign)
      • Additional findings suggestive of bowel necrosis on CT:
  • In addition to these findings, a CT scan may be useful in determining the following:
    • Diaphragmatic defects
    • Free air or fluid in the abdomen
    • Other sources of symptoms within the abdominal cavity
Twisted bowel is shown. Courtesy of James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18076966
Whirlpool sign is seen in the abdomen. Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/8490">rID: 8490</a>

References

  1. Catalano O (1996). "Computed tomographic appearance of sigmoid volvulus". Abdom Imaging. 21 (4): 314–7. PMID 8661573.
  2. Levsky JM, Den EI, DuBrow RA, Wolf EL, Rozenblit AM (2010). "CT findings of sigmoid volvulus". AJR Am J Roentgenol. 194 (1): 136–43. doi:10.2214/AJR.09.2580. PMID 20028915.


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