How do you detect a volvulus on an X-ray?

The key radiologic features of sigmoid volvulus are those of a double-loop obstruction, which has been reported in approximately 50% of patients. The key finding consists of a dilated loop of pelvic colon, associated with features of small-bowel obstruction and retention of feces in an undistended proximal colon.

Which of the following signs of sigmoid volvulus is shown on this plain abdominal radiograph?

Plain radiograph Abdominal radiographs will show a large, dilated loop of the colon, often with a few gas-fluid levels. Specific signs include: coffee bean sign. Frimann-Dahl sign – three dense lines converge towards the site of obstruction.

How do you diagnose a volvulus?

In testing for volvulus, the following tests may be performed:

1. A stool sample test finds blood in the stool.
2. An upper GI X-ray with small bowel follow-through shows a malrotated bowel or midgut volvulus.
3. A CT scan may show evidence of intestinal obstruction.

What happens sigmoid volvulus?

The sigmoid colon is an S-shaped part of the colon that is in the left lower side of the abdomen, above the rectum. With age, this part of the colon or its attachments to the abdominal wall stretch out, allowing it to twist on itself, similar to the twisting of a long balloon, resulting in a volvulus.

Why is sigmoid volvulus more common?

Sigmoid volvulus is more common in Africa, as the food intake is of high fiber and the base of the sigmoid mesentery in the African population is narrow compared with other ethnic groups, leading to an anatomical situation that makes the population more susceptible to developing a sigmoid volvulus.

Is Megacolon reversible?

In most cases, megacolon is reversible. This depends on whether it is possible to treat the underlying cause. In acute and toxic megacolon, the underlying cause can usually be treated or otherwise resolves itself naturally, so dilation of the colon is reversed.

Where is volvulus most common?

The most common sites of volvulus are the sigmoid colon and cecum [1-4]. Volvulus of other portions of the alimentary tract, such as the stomach, gallbladder, small bowel, splenic flexure, and transverse colon, are rare.

Why is sigmoid volvulus serious?

This situation can lead to death of the blood-starved tissue and tearing of the intestinal wall—a life-threatening event and a medical emergency. Sigmoid volvulus—twisting of the sigmoid colon—accounts for the majority of cases, with cecal volvulus—twisting of the cecum and ascending colon—occurring less frequently.

What happens if a volvulus is left untreated?

If left untreated, the parts of the bowels that are not receiving enough blood will start to die. Volvulus of the small intestine usually occurs in infants and children. In adults, volvulus of the small intestine is rare. In adults, volvulus tends to occur in the colon and is known as a sigmoid volvulus.

How long can you live with a twisted colon?

Without any fluids (either as sips, ice chips or intravenously) people with a complete bowel obstruction most often survive a week or two. Sometimes it’s only a few days, sometimes as long as three weeks. With fluids, survival time may be extended by a few weeks or even a month or two.

What is the treatment for sigmoid volvulus?

Nonoperative detorsion is advocated as the primary treatment choice in uncomplicated acute sigmoid volvulus. Although rectal tubes, barium enemas or rigid sigmoidoscopy have been widely used, flexible sigmoidoscopy is now the preferred nonoperative procedure.

How serious is volvulus?

The twisting causes bowel obstructions that may cut off the blood supply to areas of the bowels. A volvulus is a medical emergency that needs surgical treatment. If left untreated, the parts of the bowels that are not receiving enough blood will start to die.

What are the radiographic findings of sigmoid volvulus?

The X-marks-the-spot and split-wall signs were present in nine of 21 (43%) and 11 of 21 (52%) patients, but one of the two signs was present in 18 of 21 patients (86%). Classic radiographic and definitive cross-sectional findings were seen in 11 of 21 (52%) and 16 of 21 (76%) patients.

What are the results of a CT scan of a sigmoid?

The most sensitive scanogram findings were absence of rectal gas (19 of 21 cases, 90%) and an inverted-U-shaped distended sigmoid (18 of 21 cases, 86%) followed by the coffee bean sign and disproportionate sigmoid enlargement (both 16 of 21 cases, 76%).

What happens if acute sigmoid volvulus is left untreated?

Acute sigmoid volvulus is defined as torsion of the sigmoid colon around its mesenteric axis, which leads to acute large intestine obstruction, which, if left untreated, often results in life-threatening complications, such as bowel ischemia, gangrene, and perforation[1,2].

Can a PEC be performed for Sigmoid volvulus?

Occasionally patients suffer from recurrent sigmoid volvulus, for which a surgeon may consider sigmoid colopexy (surgical fixation of the sigmoid colon), or in the surgically unfit, a percutaneous endoscopic colostomy (PEC) might be performed. The mortality rate is 20-25% 7. The most serious complication is bowel ischemia.