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{{Volvulus}}
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== Overview ==
==Overview==
* The page name should be '''"[Disease name] diagnostic study of choice"''', with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
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.
* '''Goal:'''
**To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
**To describe the gold standard test for the diagnosis of [disease name].  
**To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
* As with all microchapter pages linking to the main page, at the top of the edit box put <nowiki>{{CMG}}</nowiki>, your name template, and the microchapter navigation template you created at the beginning.
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* Remember to follow the same format and capitalization of letters as outlined in the template below.
* You should include the name of the disease in the first sentence of every subsection.


== Diagnostic Study of Choice ==
==Diagnostic Study of Choice==


===== Template statements =====
===Study of choice:===
*There is no single diagnostic study of choice for the diagnosis of volvulus.<ref name="pmid8661573">{{cite journal |vauthors=Catalano O |title=Computed tomographic appearance of sigmoid volvulus |journal=Abdom Imaging |volume=21 |issue=4 |pages=314–7 |year=1996 |pmid=8661573 |doi= |url=}}</ref><ref name="pmid20028915">{{cite journal |vauthors=Levsky JM, Den EI, DuBrow RA, Wolf EL, Rozenblit AM |title=CT findings of sigmoid volvulus |journal=AJR Am J Roentgenol |volume=194 |issue=1 |pages=136–43 |year=2010 |pmid=20028915 |doi=10.2214/AJR.09.2580 |url=}}</ref><ref name="pmid2643910">{{cite journal |vauthors=Mangiante EC, Croce MA, Fabian TC, Moore OF, Britt LG |title=Sigmoid volvulus. A four-decade experience |journal=Am Surg |volume=55 |issue=1 |pages=41–4 |year=1989 |pmid=2643910 |doi= |url=}}</ref><ref name="pmid18200442">{{cite journal |vauthors=Oh SK, Han BK, Levin TL, Murphy R, Blitman NM, Ramos C |title=Gastric volvulus in children: the twists and turns of an unusual entity |journal=Pediatr Radiol |volume=38 |issue=3 |pages=297–304 |year=2008 |pmid=18200442 |doi=10.1007/s00247-007-0709-5 |url=}}</ref><ref name="pmid8897623">{{cite journal |vauthors=Long FR, Kramer SS, Markowitz RI, Taylor GE |title=Radiographic patterns of intestinal malrotation in children |journal=Radiographics |volume=16 |issue=3 |pages=547–56; discussion 556–60 |year=1996 |pmid=8897623 |doi=10.1148/radiographics.16.3.8897623 |url=}}</ref>
*Volvulus can be diagnosed based on clinical findings and on the findings on [[Computed tomography|CT]] scan, plain [[X-rays|x-ray]] or plain [[X-rays|x-ray]] with [[Contrast medium|contrast]].
*The initial investigation can be a plain [[X-rays|x-ray]] without contrast, or a [[Computed tomography|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-rays|x-ray]] without [[Contrast medium|contrast]] maybe performed as the initial diagnostic test when a patient presents with [[abdominal pain]], [[distension]], [[constipation]]/[[obstipation]] and [[Nausea and vomiting|nausea]].
**The following result of plain [[X-rays|x-ray]] is indicative of volvulus:
***[[Sigmoid colon|Sigmoid]]/[[Cecum|cecal]]/[[Ileum|ileal]] volvulus: U-shaped, distended segment of colon seen as an ahaustral collection of gas
***[[Stomach|Gastric]] volvulus: Single, large, spherical gas bubble located in the upper abdomen or chest with an air-fluid level
*Following a plain [[X-rays|x-ray]], a plain [[X-rays|x-ray]] with [[Lower gastrointestinal series|contrast barium enema]] may be performed.
*Alternatively, the initial test may be a [[Computed tomography|CT]] scan.
**The abdominal [[Computed tomography|CT]] should be performed when the patient presents with symptoms of [[abdominal pain]], [[distension]], [[constipation]]/[[Constipation|obstipation]] and [[Nausea and vomiting|nausea]].
**The following result of abdominal [[Computed tomography|CT]] is indicative of volvulus:
***[[Sigmoid colon|Sigmoid]]/[[Cecum|Cecal]]/[[Ileus|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
*In addition to these findings, a [[Computed tomography|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-rays|x-ray]] with [[Lower gastrointestinal series|contrast barium enema]] is indicative of volvulus:
**Bird beak appearance or twisted tapering of afferent and efferent colonic segments
*Plain [[X-rays|x-ray]] with [[Lower gastrointestinal series|contrast barium enema]] can be utilized in the following circumstances:
**Therapeutically in an attempt to reduce volvulus
**If plain [[X-rays|x-ray]] is not diagnostic and [[Computed tomography|CT]] is not available
*Plain [[X-rays|x-ray]] with [[Lower gastrointestinal series|contrast barium enema]] is contraindicated in:
**[[Peritonitis]]
**[[Pneumoperitoneum]]
**Necrotic bowel
If diagnosis cannot be established with a plain [[X-rays|x-ray]] with or without [[Contrast medium|contrast]], or with a [[Computed tomography|CT]] scan then a [[Laparoscopic surgery|laparoscopy]]/[[laparotomy]] can be used.


=== Gold standard/Study of choice: ===
=====Sequence of Diagnostic Studies=====
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
Initially, a plain abdominal [[X-rays|x-ray]] or [[Computed tomography|CT]] may be performed. A plain abdominal [[X-rays|x-ray]] may be followed by a plain [[X-rays|x-ray]] with [[Contrast medium|contrast]] to help determine diagnosis or to identify complications. A [[Computed tomography|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-rays|x-ray]].
* The following result of [gold standard test] is confirmatory of [disease name]:
** Result 1
** Result 2
* The [name of investigation] should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison table for diagnostic studies of choice for [disease name] ====
===Diagnostic Criteria===
{|
*Volvulus is mainly diagnosed based on clinical presentation and imaging findings on [[X-rays|x-ray]] and [[Computed tomography|CT]].
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
*There are no established criteria for the diagnosis of volvulus.
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>
 
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Latest revision as of 23:58, 8 January 2018


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 segment of 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
  • 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:
  • 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:

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

  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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.

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