Imaging

Volvulus

Preliminary Diagnosis: Volvulus

I. What imaging technique is first-line for this diagnosis?

CT abdomen/pelvis with IV and PO contrast with multiplanar reconstructions. A volvulus is best demonstrated when the imaging axis is perpendicular to the axis of rotation, and therefore multiplanar reconstructions increases the sensitivity of volvulus detection. If a complete or high grade obstruction is suspected secondary to volvulus, then PO contrast should not be given.

II. Describe the advantages and disadvantages of this technique for diagnosing volvulus?

Advantages

  • High sensitivity and specificity for large and small bowel volvulus.

  • Identifies transition point of volvulus.

  • Identifies degree of obstruction from volvulus and any underlying intraluminal lesions.

  • Can identify complications from volvulus (i.e., perforation, bowel ischemia)

Disadvantages

CT exposes patients to ionizing radiation.

III. What are the contraindications for the first-line imaging technique?

  • If a complete or high grade obstruction is suspected secondary to voluvus, then oral contrast should not be given.

  • Due to radiation exposure, CT should be used conservatively in the pediatric population and is contraindicated in pregnancy.

  • IV contrast should not be given in patients in renal failure who are not on an adequate and CT-appropriate dialysis regimen.

IV. What alternative imaging techniques are available?

Plain radiograph.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing volvulus.

Plain radiograph

Advantages

  • For large bowel volvulus, imaging may show bowel dilatation and other signs diagnostic for a cecal or sigmoid volvulus.

Disadvantages

  • For small bowel volvulus, imaging will only show dilatation, which would indicate a small bowel obstruction. However, CT will be required to confirm small bowel volvulus as the cause of obstruction.

  • Radiographs provide limited information on degree of obstruction or complications from volvulus (i.e., ischemia), which will often affect clinical management.

VI. What are the contraindications for the alternative imaging techniques?

No contraindications.

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