Guidelines

How can you tell the difference between sigmoid and cecal volvulus?

How can you tell the difference between sigmoid and cecal volvulus?

A definitive sign of a cecal volvulus is the upward displacement of the appendix with obstruction of the large bowel. Comparatively, a sigmoid volvulus will show findings of a bent inner tube sign with the apex of the volvulus located in the left upper quadrant.

What does volvulus look like on xray?

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.

Can you see volvulus on xray?

Twisting of the bowel – or ‘volvulus’ – is a specific cause of bowel obstruction which can have characteristic appearances on an abdominal X-ray. The two commonest types of bowel twisting are sigmoid volvulus and caecal volvulus.

How is sigmoid volvulus diagnosed?

An abdominal x-ray scan may show a large dilated colon or air within the abdomen outside the intestine if there is perforation. A computed tomography scan or a contrast enema through the rectum may also be used to confirm the diagnosis.

How is cecal volvulus diagnosed?

Aside from a physical exam, your doctor will order imaging tests to help diagnose cecal volvulus. They might also feel your abdominal area to assess any areas of swelling. Imaging tests may include a CT scan or an X-ray. With these tests, your doctor can look for descending or rounding movements of the large bowel.

Why are cecal and sigmoid volvulus more common?

However, it is most common in the sigmoid colon because of the mesenteric anatomy. Less commonly, volvulus develops in the right colon and terminal ileum (cecal or cecocolic volvulus) or the cecum alone (termed a cecal bascule). In rare cases, volvulus may develop in the transverse colon or the splenic flexure.

What causes a sigmoid volvulus?

Sigmoid volvulus may occur because of sigmoid elongation, resulting in a redundant loop. Most commonly, this is the result of chronic constipation and the progressive dilatation and lengthening of the sigmoid colon and its mesentery.

How do you treat a 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.

What is the most common location of a volvulus?

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.

What triggers volvulus?

Risk factors for volvulus include intestinal malrotation, Hirschsprung disease, an enlarged colon, pregnancy, and abdominal adhesions. A higher incidence of volvulus is also noticed among hospitalized patients with neuropsychiatric disorders such as Parkinson’s disease, multiple sclerosis, etc.

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