Volvulus diagnostic study of choice: Difference between revisions

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===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 can be a plain x-ray without contrast, or a CT scan.
*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.
*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.
*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-ray is indicative of volvulus:
**The following result of plain [[X-rays|x-ray]] is indicative of volvulus:
***Sigmoid/cecal/ileal volvulus: U-shaped, distended sigmoid colon seen as an ahaustral collection of gas
***[[Sigmoid colon|Sigmoid]]/[[Cecum|cecal]]/[[Ileum|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
***[[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.  
*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 CT scan.
*Alternatively, the initial test may be a [[Computed tomography|CT]] scan.
**The abdominal CT should be performed when the patient presents with symptoms of abdominal pain, distension, constipation/obstipation and nausea.
**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 CT is indicative of volvulus:
**The following result of abdominal [[Computed tomography|CT]] is indicative of volvulus:
***Sigmoid/Cecal/Ileal volvulus:
***[[Sigmoid colon|Sigmoid]]/[[Cecum|Cecal]]/[[Ileus|Ileal]] volvulus:
****Whirl pattern signifying a dilated colon
****Whirl pattern signifying a dilated bowel
****Bird beak appearance of afferent and efferent colonic segments  
****Bird beak appearance of afferent and efferent colonic segments  
****Absence of rectal gas
****Absence of rectal gas
****Separation of the sigmoid walls by adjacent mesenteric fat (split wall sign)  
****Separation of the sigmoid walls by adjacent mesenteric fat (split wall sign)  
***Additional findings suggestive of bowel necrosis:  
***Additional findings suggestive of bowel [[necrosis]]:  
****Presence of air in the intestines (pneumatosis intestinalis)
****Presence of air in the intestines ([[pneumatosis intestinalis]])
****Portal venous gas
****Portal venous gas
****Loss of bowel wall enhancement
****Loss of bowel wall enhancement
*In addition to these findings, a CT scan may be useful in determining the following:
*In addition to these findings, a [[Computed tomography|CT]] scan may be useful in determining the following:
**Diaphragmatic defects  
**Diaphragmatic defects  
**Free air or fluid in the abdomen
**Free air or fluid in the abdomen
**Other sources of symptoms within the abdominal cavity   
**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-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-ray with or without contrast, or with a CT scan then a laparoscopy/laparotomy can be used.  
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 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.
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.


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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