Volvulus diagnostic study of choice: Difference between revisions
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==Overview== | ==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== | ==Diagnostic Study of Choice== | ||
=== | ===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> | *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 CT scan, plain x-ray or plain x-ray with contrast. | *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 | *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: | |||
*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. | ***[[Sigmoid colon|Sigmoid]]/[[Cecum|cecal]]/[[Ileum|ileal]] volvulus: U-shaped, distended segment of colon seen as an ahaustral collection of gas | ||
*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. | ***[[Stomach|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-rays|x-ray]], a plain [[X-rays|x-ray]] with [[Lower gastrointestinal series|contrast barium enema]] may be performed. | ||
*The following result of abdominal CT is indicative of volvulus: | *Alternatively, the initial test may be a [[Computed tomography|CT]] scan. | ||
**Sigmoid/Cecal/Ileal volvulus: | **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]]. | ||
***Whirl pattern signifying a dilated | **The following result of abdominal [[Computed tomography|CT]] is indicative of volvulus: | ||
***Bird beak appearance of afferent and efferent colonic segments | ***[[Sigmoid colon|Sigmoid]]/[[Cecum|Cecal]]/[[Ileus|Ileal]] volvulus: | ||
***Absence of rectal gas | ****Whirl pattern signifying a dilated bowel | ||
***Separation of the sigmoid walls by adjacent mesenteric fat (split wall sign) | ****Bird beak appearance of afferent and efferent colonic segments | ||
**Additional findings suggestive of bowel necrosis: | ****Absence of rectal gas | ||
***Presence of air in the intestines (pneumatosis intestinalis) | ****Separation of the sigmoid walls by adjacent mesenteric fat (split wall sign) | ||
***Portal venous gas | ***Additional findings suggestive of bowel [[necrosis]]: | ||
***Loss of bowel wall enhancement | ****Presence of air in the intestines ([[pneumatosis intestinalis]]) | ||
* | ****Portal venous gas | ||
*** | ****Loss of bowel wall enhancement | ||
*The following result of plain x-ray with contrast barium enema is indicative of volvulus: | *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 | **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-rays|x-ray]] with [[Lower gastrointestinal series|contrast barium enema]] can be utilized in the following circumstances: | ||
**Therapeutically in an attempt to reduce volvulus | **Therapeutically in an attempt to reduce volvulus | ||
**If plain x-ray is not diagnostic and CT is not available | **If plain [[X-rays|x-ray]] is not diagnostic and [[Computed tomography|CT]] is not available | ||
*Plain x-ray with contrast barium enema is contraindicated in: | *Plain [[X-rays|x-ray]] with [[Lower gastrointestinal series|contrast barium enema]] is contraindicated in: | ||
**Peritonitis | **[[Peritonitis]] | ||
**Pneumoperitoneum | **[[Pneumoperitoneum]] | ||
**Necrotic bowel | **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. | |||
=====Sequence of Diagnostic Studies===== | =====Sequence of Diagnostic Studies===== | ||
Initially a plain abdominal x-ray | 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]]. | ||
===Diagnostic Criteria=== | ===Diagnostic Criteria=== | ||
*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-rays|x-ray]] and [[Computed tomography|CT]]. | ||
*There are no established criteria for the diagnosis of volvulus. | *There are no established criteria for the diagnosis of volvulus. | ||
==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.
- 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.