Volvulus CT
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Volvulus Microchapters |
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Volvulus CT On the Web |
American Roentgen Ray Society Images of Volvulus CT |
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:
- Presence of air in the intestines (pneumatosis intestinalis)
- Portal venous gas
- Loss of bowel wall enhancement
- Sigmoid, cecal, ileal volvulus:
- The following result of abdominal CT is indicative of 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