Volvulus diagnostic study of choice
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
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Overview
There is no single diagnostic study of choice for the diagnosis of volvulus. Volvulus can be diagnosed based on clinical findings and on the findings on CT scan, plain x-ray or plain x-ray with contrast.
Diagnostic Study of Choice
Study of choice:
- There is no single diagnostic study of choice for the diagnosis of volvulus.[1][2][3][4][5]
- Volvulus can be diagnosed based on clinical findings and on the findings on CT scan, plain x-ray or plain x-ray with contrast.
- The initial investigation can be a plain x-ray without contrast, or a CT scan.
- It is important to rule out pneumoperitoneum, this means that a perforation in the bowel has occurred and that air is in the peritoneum. It is a surgical emergency.
- A plain x-ray without contrast maybe performed as the initial diagnostic test when a patient presents with abdominal pain, distension, constipation/obstipation and nausea.
- Following a plain x-ray, a plain x-ray with contrast barium enema may be performed.
- Alternatively, the initial test may be a CT scan.
- The abdominal CT should be performed when the patient presents with symptoms of abdominal pain, distension, constipation/obstipation and nausea.
- 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:
- Presence of air in the intestines (pneumatosis intestinalis)
- Portal venous gas
- Loss of bowel wall enhancement
- Sigmoid/Cecal/Ileal volvulus:
- 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
- The following result of plain x-ray with contrast barium enema is indicative of volvulus:
- Bird beak appearance or twisted tapering of afferent and efferent colonic segments
- Plain x-ray with contrast barium enema can be utilized in the following circumstances:
- Plain x-ray with contrast barium enema is contraindicated in:
- Peritonitis
- Pneumoperitoneum
- Necrotic bowel
If diagnosis cannot be established with a plain x-ray with or without contrast, or with a CT scan then a laparoscopy/laparotomy can be used.
Sequence of Diagnostic Studies
Initially, a plain abdominal x-ray or CT may be performed. A plain abdominal x-ray may be followed by a plain x-ray with contrast to help determine diagnosis or to identify complications. 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.
Diagnostic Criteria
- Volvulus is mainly diagnosed based on clinical presentation and imaging findings on x-ray and CT.
- There are no established criteria for the diagnosis of volvulus.
References
- ↑ Catalano O (1996). "Computed tomographic appearance of sigmoid volvulus". Abdom Imaging. 21 (4): 314–7. PMID 8661573.
- ↑ 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.
- ↑ Mangiante EC, Croce MA, Fabian TC, Moore OF, Britt LG (1989). "Sigmoid volvulus. A four-decade experience". Am Surg. 55 (1): 41–4. PMID 2643910.
- ↑ Oh SK, Han BK, Levin TL, Murphy R, Blitman NM, Ramos C (2008). "Gastric volvulus in children: the twists and turns of an unusual entity". Pediatr Radiol. 38 (3): 297–304. doi:10.1007/s00247-007-0709-5. PMID 18200442.
- ↑ Long FR, Kramer SS, Markowitz RI, Taylor GE (1996). "Radiographic patterns of intestinal malrotation in children". Radiographics. 16 (3): 547–56, discussion 556–60. doi:10.1148/radiographics.16.3.8897623. PMID 8897623.