Tag Archives: Volvulus

More colonic dilitation…

June 9, 2014

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This patient presented with abdominal pain, nausea, vomiting, and distention:

Volvulus 1 Volvulus 2 Cecal Volvulus 2 Cecal Volvulus

These films and CT show colonic dilatation similar to last week (sigmoid volvulus).  However, in contrast to last week, this is a cecal volvulus.  In this CT there is marked dilatation of the cecum with a central location in the abdomen.  Usually a cecal volvulus will have visible haustra as opposed to a sigmoid volvulus in which colonic haustra will not be present.  Sometimes, as in the above images, the haustra are difficult to see.  This also looks like it may be a more rare form of cecal volvulus called a cecal bascule.  For more information I will defer to our radiology colleagues at Radiopaedia:

Caecal Volvulus

For all you radiologists out there, do you think this is consistent with a cecal bascule?

Why note the difference between cecal and sigmoid volvulus?  The treatment can be drastically different.  Sigmoid volvuli are many times amenable to acute management non-operatively (sigmoidoscopy) whereas cecal volvuli usually require open laparotomy and have a higher frequency of partial colectomy.

Author:  Russell Jones, MD

References

1.   Gaillard F et al.  Caecal Volvulus. http://radiopaedia.org/articles/caecal_volvulus

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Colonic dilitation…

June 2, 2014

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This is a 50 year old male who presented with nausea, vomiting, and abdominal distention.  His initial plain film showed:

CV 1

A CT scan was ordered for given suspicion for colonic obstruction:

CV Scout 1 CT Swirl 1

 

The CT scout film clinches the diagnosis with the classic “Coffee Bean” sign consistent with a sigmoid volvulus. The CT scan not only shows the massively dilated colon but demonstrates the associated “swirl” sign of the mesentery (arrow). He underwent a flexible sigmoidoscopy with partial reduction of his volvulus.  He then underwent a colectomy for definitive management of his volvulus.  He had a return of bowel function and discharged a week later.

Author:  John Ray, MD

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