Imaging in volvulus

Imaging in volvulus

/uni25CF In caecal volvulus, radiological abnormalities are iden tifiable in nearly all patients but are often non-specific, with caecal dilatation (98–100%), a single air–fluid level (72–88%), small bowel dilatation (42–55%) and absence of gas in distal colon (82–91%) reported as the most common abnormalities. A barium enema may be used to confirm the diagnosis if there are no concerns about ischaemia, with an absence of barium in the caecum and a bird’s beak deformity . CT scanning is now the imaging of choice. /uni25CF In sigmoid volvulus, a plain radiograph shows massive colonic distension. The classic appearance is of a dilated loop of bowel; the two limbs are seen running diagonally across the abdomen from right to left ( Figure 78.14 two fluid levels seen, one within each loop of bowel (if an erect film is taken). /uni25CF In volvulus neonatorum, the abdominal radiograph shows a variable appearance. Initially , it may appear normal or show evidence of duodenal obstruction but, as the intestinal strangulation progresses, the abdomen becomes relatively gasless.