Volvulus x ray

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

An x-ray (with or without contrast) may be helpful in the diagnosis of volvulus. Findings on an x-ray suggestive of sigmoid, cecal and ileal volvulus include: U-shaped, distended segment of colon seen as an ahaustral collection of gas volvulus. Findings on an x-ray suggestive of gastric volvulus includes a single, large, spherical gas bubble located in the upper abdomen or chest with an air-fluid level. It is important to rule out pneumoperitoneum before carrying out a barium enema.

X Ray

A plain x-ray without contrast may be helpful in the diagnosis of volvulus. Findings on an x-ray suggestive of volvulus include:^[1]^[2]^[3]
- Sigmoid/cecal/ileal volvulus: U-shaped, distended segment of colon seen as an ahaustral collection of gas
- Gastric volvulus: Single, large, spherical gas bubble located in the upper abdomen or chest with an air-fluid level
The following result of plain x-ray with contrast barium enema is indicative of volvulus:
- Bird beak appearance or twisted tapering of afferent and efferent colonic segments
Plain x-ray with contrast barium enema can be utilized in the following circumstances:
- Therapeutically in an attempt to reduce volvulus
- If plain x-ray is not diagnostic and CT is not available
Plain x-ray with contrast barium enema is contraindicated in:
- Peritonitis
- Pneumoperitoneum
- Necrotic bowel

It is important to rule out pneumoperitoneum, this means that a perforation in the bowel has occurred and that air is in the peritoneum. It is a surgical emergency.

“Coffee bean sign” seen in sigmoid volvulus. Courtesy of Hellerhoff – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=27617915

References

↑ Mangiante EC, Croce MA, Fabian TC, Moore OF, Britt LG (1989). “Sigmoid volvulus. A four-decade experience”. Am Surg. 55 (1): 41–4. PMID 2643910.
↑ Oh SK, Han BK, Levin TL, Murphy R, Blitman NM, Ramos C (2008). “Gastric volvulus in children: the twists and turns of an unusual entity”. Pediatr Radiol. 38 (3): 297–304. doi:10.1007/s00247-007-0709-5. PMID 18200442.
↑ Long FR, Kramer SS, Markowitz RI, Taylor GE (1996). “Radiographic patterns of intestinal malrotation in children”. Radiographics. 16 (3): 547–56, discussion 556–60. doi:10.1148/radiographics.16.3.8897623. PMID 8897623.

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[pmid2643910-1] Mangiante EC, Croce MA, Fabian TC, Moore OF, Britt LG (1989). “Sigmoid volvulus. A four-decade experience”. Am Surg. 55 (1): 41–4. PMID 2643910.

[pmid18200442-2] Oh SK, Han BK, Levin TL, Murphy R, Blitman NM, Ramos C (2008). “Gastric volvulus in children: the twists and turns of an unusual entity”. Pediatr Radiol. 38 (3): 297–304. doi:10.1007/s00247-007-0709-5. PMID 18200442.

[pmid8897623-3] Long FR, Kramer SS, Markowitz RI, Taylor GE (1996). “Radiographic patterns of intestinal malrotation in children”. Radiographics. 16 (3): 547–56, discussion 556–60. doi:10.1148/radiographics.16.3.8897623. PMID 8897623.

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