Fact-sheet: Colonic volvulus
Updated on 04/18/2023 at 12:38 PM
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Definition
The different forms of colonic volvulus are:
- sigmoid volvulus, the most frequent,
- cecal volvulus, the second most frequent form, favored by a defect of fusion of the right Toldt fascia and more common in elderly women,
- transverse colon volvulus, which is thought to be favored by elongation of the transverse mesocolon or a defect in fixation of the right colon,
- and volvulus of the splenic flexure, the rarest, favored by a fusion defect, postoperative adhesions, or chronic constipation.
Clinical features
Sigmoid volvulus,
the most frequent form of colonic volvulus.
Predisposing factors: dolichosigmoid, elderly patient, prolonged bed rest, institutionalization.
Two forms: mesenterico-axial or organoaxial
Radiography
Cecal volvulus: Gaseous distension of the cecum, which tilts anteriorly to the right colon, or into the left upper quadrant
CT
Cecal volvulus:
- Empty right iliac fossa
- Markedly distended cecum, abnormally located in the LUQ or the LIF
- Terminal ileal loop arising from the right border of the cecum, reflecting cecal rotation
- Beak sign just proximal to the transition zone
- Whirl sign, more or less pronounced depending on the severity of the volvulus
- Possible signs of wall ischemia
- Mechanical obstructive pattern with possible upstream small bowel dilation in case of an incompetent ileocecal valve.
Sigmoid volvulus:
-apposition in a central abdominal position of the two markedly distended limbs of the sigmoid loop
-a sigmoid loop extending above the transverse colon in a cranial direction (northern hemisphere sign)
-normal topography of the remainder of the colonic frame
-a double-beak sign at the crossing point of the two sigmoid limbs (in the mesenterico-axial form)
-a whirl sign
-possible wall ischemia
-mechanical colonic obstructive pattern.
Organoaxial form:
-Torsion of the distal limb about its own axis
-Without involvement of the proximal limb.
Mesenterico-axial form:
-Classically described form
-Closed-loop obstruction
-Torsion of the sigmoid around its mesentery causing
coiling of the 2 limbs
-"Beak-like" stenosis on each limb
Management
Sigmoid volvulus:
-Emergency endoscopic reduction (decompression) in the absence of complications, followed by surgical treatment during the same hospital stay (recurrence risk +++)
-Immediate surgery if CT signs of severity are present
