How do you identify a sigmoid volvulus?
How do you identify a sigmoid volvulus?
Plain radiograph Abdominal radiographs will show a large, dilated loop of the colon, often with a few gas-fluid levels. Specific signs include: coffee bean sign. Frimann-Dahl sign – three dense lines converge towards the site of obstruction.
How can you distinguish between a cecal sigmoid and a volvulus?
A definitive sign of a cecal volvulus is the upward displacement of the appendix with obstruction of the large bowel. Comparatively, a sigmoid volvulus will show findings of a bent inner tube sign with the apex of the volvulus located in the left upper quadrant.
What happens sigmoid volvulus?
Sigmoid volvulus is the most common type of colonic volvulus and occurs when a portion of the intestine twists around its blood supply. In sigmoid volvulus, this occurs at the base of the mesentery. It most commonly presents in patients who are bedbound and have a history of chronic constipation.
What is the most common location of a volvulus?
The most common sites of volvulus are the sigmoid colon and cecum [1-4]. Volvulus of other portions of the alimentary tract, such as the stomach, gallbladder, small bowel, splenic flexure, and transverse colon, are rare.
What is the radiographic appearance of volvulus?
Radiographic findings that may be diagnostic of sigmoid volvulus include a large air-filled bowel loop, which represents the sigmoid colon, arising from the pelvis and extending cranially beyond the level of the transverse colon (the “northern exposure” sign) (Figs 18–23) (10,15).
What shape does a sigmoid volvulus appear as?
Plain radiographs show a markedly distended sigmoid loop, which assumes a bent inner tube or inverted U -shaped appearance, with the limbs of the sigmoid loop directed toward the pelvis. The colonic haustra are lost, and progressive distention elevates the sigmoid loop under one side of the diaphragm.
How do you diagnose volvulus?
Diagnosis of volvulus will typically require traditional x-rays and imaging, during which time doctors will look for a telltale “coffee bean” shape or “bent inner tube” shape in the bowel. A barium enema may also be performed in order to enhance the imaging of the potential obstruction.
Why does sigmoid volvulus occur?
Sigmoid volvulus may occur because of sigmoid elongation, resulting in a redundant loop. Most commonly, this is the result of chronic constipation and the progressive dilatation and lengthening of the sigmoid colon and its mesentery.
What are the causes of sigmoid volvulus?
These include chronic constipation, high-fiber diet, chronic dependence on enemas or laxatives, association with neuropsychiatric disorders and myopathies, the use of neuroleptic drugs, etc. Similarly, Chagas disease or megacolon can also predispose to sigmoid volvulus.
How is volvulus diagnosed?
Is a sigmoid volvulus life threatening?
In addition, the blood supply may be reduced, leading to injury or death of the tissues of that part of the colon. If not treated quickly, this can result in a perforation, a hole in the bowel through which stool and gas can spill into the abdomen. Perforations can be fatal without urgent intervention.
What are the signs and symptoms of sigmoid volvulus?
Coffee bean sign, whirl sign and bird’s beak sign in the diagnosis of sigmoid volvulus Coffee bean sign, whirl sign and bird’s beak sign in the diagnosis of sigmoid volvulus Pan Afr Med J.
What does an enema showing the classic bird’s beak indicate?
-Gastrografin enema showing the classic bird’s beak, sign of sigmoid volvulus. Source publication Volvulus of the sigmoid colon in a child Article Full-text available Jun 2002 Ghassan Al-Kouder Akhtar Nawaz Cirus Gerami Ahmed Al-Salem
What are the symptoms of large Bowel volvulus?
Large bowel volvulus accounts for ~5% of all large bowel obstructions, with ~60% of intestinal volvulus involving the sigmoid colon 6. It is more common in the elderly 7. Symptoms are that of large bowel obstruction: constipation, abdominal bloating, nausea and/or vomiting. Onset may be acute or chronic.
Is gastrograffin enema effective for the treatment of sigmoid volvulus?
The patient was suspected for sigmoid volvulus on x-ray (unfortunately, not available). Subsequently, gastrograffin enema was performed for therapeutic detorsion of the volvulus. However, therapeutic detorsion by gastrograffin enema was not achieved and the patient underwent sigmoidoscopy which finally relieved the volvulus.