Volvulus CT: Difference between revisions
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==Overview== | ==Overview== | ||
The initial investigation for volvulus can be a plain [[X-rays|x-ray]] without contrast, or a [[Computed tomography|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== | ==CT== | ||
*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]].<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> | |||
*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 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]] on CT: | |||
****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 | |||
[[Image:volvulus.png|thumb|center|500px|Twisted bowel is shown. Courtesy of James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18076966]] | |||
[[Image:whirlpool.gif|thumb|center|500px|Whirlpool sign is seen in the abdomen. Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/8490">rID: 8490</a>]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category: | |||
[[Category:Disease]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Imaging]] | |||
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{{WH}} | |||
Latest revision as of 00:05, 9 January 2018
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Volvulus Microchapters |
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Volvulus CT On the Web |
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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
