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. | 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== | ||
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*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]]. | *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: | **The following result of abdominal [[Computed tomography|CT]] is indicative of volvulus: | ||
***[[Sigmoid colon|Sigmoid]] | ***[[Sigmoid colon|Sigmoid]], [[Cecum|cecal]], [[Ileus|ileal]] volvulus: | ||
****Whirl pattern signifying a dilated bowel | ****Whirl pattern signifying a dilated bowel | ||
****Bird beak appearance of afferent and efferent colonic segments | ****Bird beak appearance of afferent and efferent colonic segments | ||
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**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 | ||
[[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== | ||
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[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Imaging]] | |||
{{WS}} | {{WS}} | ||
{{WH}} | {{WH}} | ||
Latest revision as of 00:05, 9 January 2018
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Volvulus Microchapters |
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Treatment |
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Case Studies |
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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
