Volvulus diagnostic study of choice: Difference between revisions
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*Volvulus can be diagnosed based on clinical findings and on the findings on CT scan, plain x-ray or plain x-ray with contrast. | *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. | *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. | |||
**The following result of plain x-ray is indicative of volvulus: | **The following result of plain x-ray is indicative of volvulus: | ||
***Sigmoid/ | ***Sigmoid/cecal/ileal volvulus: U-shaped, distended sigmoid colon seen as an ahaustral collection of gas | ||
***Gastric volvulus: Single, large, spherical gas bubble located in the upper abdomen or chest with an air-fluid level | ***Gastric volvulus: Single, large, spherical gas bubble located in the upper abdomen or chest with an air-fluid level | ||
*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. | |||
*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 abdominal CT should be performed when: | ||
***The patient presented with symptoms of abdominal pain, distension, constipation/obstipation and nausea. | ***The patient presented 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 colon | |||
****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 | |||
*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: | *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 | **Bird beak appearance or twisted tapering of afferent and efferent colonic segments | ||
| Line 40: | Line 45: | ||
**Pneumoperitoneum | **Pneumoperitoneum | ||
**Necrotic bowel | **Necrotic bowel | ||
*If diagnosis cannot be established with a plain x-ray with and without contrast, or a CT scan then a laparoscopy/laparotomy can be used. | |||
=====Sequence of Diagnostic Studies===== | =====Sequence of Diagnostic Studies===== | ||
| Line 47: | Line 53: | ||
*Volvulus is mainly diagnosed based on clinical presentation and imaging findings on x-ray and CT. | *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. | *There are no established criteria for the diagnosis of volvulus. | ||
==References== | ==References== | ||
Revision as of 17:15, 28 December 2017
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.
- The following result of plain x-ray is indicative of volvulus:
- Sigmoid/cecal/ileal volvulus: U-shaped, distended sigmoid colon seen as an ahaustral collection of gas
- Gastric volvulus: Single, large, spherical gas bubble located in the upper abdomen or chest with an air-fluid level
- The following result of plain x-ray is indicative of volvulus:
- 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 presented 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 colon
- 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:
- The abdominal CT should be performed when:
- 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:
- Therapeutically in an attempt to reduce volvulus
- If plain x-ray is not diagnostic and CT is not available
- 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 and without contrast, or a CT scan then a laparoscopy/laparotomy can be used.
Sequence of Diagnostic Studies
Initially a plain abdominal x-ray is carried out, a plain x-ray with contrast or CT may follow to determine complications, obstruction level, to rule out other causes of abdominal pain and obstruction, and if 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.