Gastrointestinal tract images Traditionally, cecal volvulus was suggested with conventional radiography and confirmed either with a barium enema or colonoscopy. Most often cecal volvulus is idiopathic, but occasionally it is induced by a more distal partial obstruction. Computed tomography appears to be more accurate than conventional radiography in suggesting the diagnosis, and although CT is often performed for suspected cecal volvulus, few studies have evaluated whether it is superior or even equal to a barium enema. In distinction to sigmoid volvulus, a successful therapeutic barium enema or colonoscopy is achieved only in a minority of these patients, and most undergo surgery.
This is radiology images of Cecal volvulus. A: Conventional radiograph shows a greatly dilated midabdominal loop of bowel (arrows). B: Barium enema reveals a characteristic beak sign (arrow) at the site of twist in the right colon.
Radiology images of Cecal volvulus. CT identifies a massively dilated cecum displaced to the left of midline (arrows). Dilated loops of small bowel on the right are secondary to small bowel obstruction.
Sigmoid volvulus ranges from an acute condition, often associated with strangulation, to a chronic setting,with the patient presenting with a gradual onset or intermittent obstruction. An immediate concern is to ascertain that this is indeed idiopathic sigmoid volvulus rather than a sigmoid or rectal cancer-induced colonic obstruction. Sigmoid volvulus occasionally develops during pregnancy and after gynecologic and other abdominal surgery. Imaging findings of sigmoid volvulus are familiar to most radiologists. A CT whirl pattern consists of a twisted, dilated sigmoid loop and its associated vessels around the mesocolon. If the transverse colon can be identified on radiographs (with the patient supine), a dilated sigmoid colon located cephalad to the transverse colon is an accurate finding of sigmoid volvulus.
The preferred therapy for acute sigmoid volvulus is decompression either by endoscopy or barium enema, followed, if indicated, by elective sigmoid resection. Simple sigmoid decompression does relieve obstruction but volvulus tends to recur if no resection or fixation is performed. A surgical nonresective procedure consists of extraperitonealization of the sigmoid colon by placing it in the infraumbilical abdominal wall.
This is radiology images of sigmoid volvulus. A lateral view from a barium enema identifies a typical twist (arrow), shows barium in a dilated sigmoid and excludes a carcinoma as etiology for the obstruction.