Fact-sheet: Colonic volvulus
Updated on 04/18/2023 at 12:38 PM
View all RADEOS cases associated with this fact-sheet
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