Underdiagnosed Distal Colonic Volvuli on MDCT Imaging

DOI: 10.4236/ss.2014.53020   PDF   HTML   XML   4,095 Downloads   5,008 Views  


Volvuli affecting the distal colon, specifically the splenic flexure onwards is underdiagnosed pathologies with non-specific clinical features. Delay in diagnosing these pathologies can lead to significant morbidity and mortality in terms of ischemia and perforation of bowel. Multi detector computed tomography (MDCT) with intravenous contrast is an accurate and reliable imaging modality allowing prompt diagnosis and management. We present an overview of the radiological features found in acute presentations of different types of colonic volvuli.

Share and Cite:

Kumar, M. , Vijayakumar, S. and Dev, B. (2014) Underdiagnosed Distal Colonic Volvuli on MDCT Imaging. Surgical Science, 5, 105-116. doi: 10.4236/ss.2014.53020.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Parker, E. (1845) Case of Intestinal Obstruction: Sigmoid Flexure Strangulated by the Ileum. American Journal of the Medical Sciences, 11, 464-465.
[2] Shepherd, J.J. (1967) Ninety Two Cases of Ileosigmoid Knotting in Uganda. British Journal of Surgery, 54, 561-566. http://dx.doi.org/10.1002/bjs.1800540615
[3] Alver, O., Oren, D., Tireli, M., Kayabasi, B. and Akdemis, D. (1993) Ileosigmoid Knotting in Turkey: Review of 68 Cases. Diseases of the Colon & Rectum, 36, 1139-1147. http://dx.doi.org/10.1007/ BF02052263
[4] Puthu, D., Rajan, N., Shenoy, G.M. and Pai, U.S. (1991) The Ileosigmoid Knot. Diseases of the Colon & Rectum, 34, 161-166. http://dx.doi.org/10.1007/BF02049992
[5] Raveenthiran, V. (2001) The Ileosigmoid Knot: New Observation and Changing Trends. Diseases of the Colon & Rectum, 44, 1196-1200. http://dx.doi.org/10.1007/BF02234644
[6] Atamanalp, S.S., Oren, D., Basoglu, M., Yildirgan, M.I., Balik, A.A., Polat, K.Y., et al. (2004) Ileosigmoid Knotting: Outcome in 63 Patients. Diseases of the Colon & Rectum, 47, 906-910.
[7] Atamanalp, S.S., Oren, D., Yildirgan, M.I., Bosoglu, M., Aydinli, B., Ozturk, G. and Salman, B. (2007) Ileosigmoid Knotting in Children: A Review of 9 Cases. World Journal of Surgery, 31, 31-35.
[8] Akgun, Y. (1997) Management of Ileosigmoid Knotting. British Journal of Surgery, 84, 672-673. http://dx.doi.org/10.1002/bjs.1800840526
[9] Kakar, A. and Bhatnagar, B.N. (1981) Ileosigmoid Knotting: A Clinical Study of 11 Cases. Australian and New Zealand Journal of Surgery, 51, 456-458. http://dx.doi.org/10.1111/j.1445-2197.1981. tb05984.x
[10] Miller, B.J. and Borrowdale, R.C. (1992) Ileosigmoid Knotting: A Case Report and Review. Australian and New Zealand Journal of Surgery, 62, 402-404. http://dx.doi.org/10.1111/j.1445-2197.1992. tb07213.x
[11] Catalano, O. (1996) Computed Tomographic Appearance of Sigmoid Volvulus. Abdominal Imaging, 21, 314-317. http://dx.doi.org/10.1007/s002619900071
[12] Shaff, M.I., Himmelfarb, E., Sacks, G.A., et al. (1984) The Whirl Sign: A CT Finding in Volvulus of the Large Bowel. Journal of Computer Assisted Tomography, 8, 559-591.
[13] Peterson, C.M., Anderson, J.S., Hara, A.K., Carenza, J.W. and Menias, C.O. (2009) Volvulus of the Gastrointestinal Tract: Appearances at Multimodality Imaging. RadioGraphics, 29, 1281-1293.
[14] Burrell, H.C., Baker, D.M., Wardrop, P. and Evans, A.J. (1994) Significant Plain Film Findings in Sigmoid Volvulus. Clinical Radiology, 49, 317-319. http://dx.doi.org/10.1016/S0009-9260(05)81795-7
[15] Frank, A.J., Goffner, L.B., Fruauff, A.A., et al. (1993) Cecal volvulus: the CT whirl sign. Abdominal Imaging, 18, 288-289. http://dx.doi.org/10.1007/BF00198126
[16] Balthazar, E.J., Birnbaum, B.A., Megibow, A.J., et al. (1992) Closed-Loop and Strangulating Intestinal Obstruction: CT Signs. Radiology, 185, 769-775.
[17] Hirao, K., Kikawada, M., Hanyu, H., et al. (2006) Sigmoid Volvulus Showing “a Whirl Sign” on CT. Internal Medicine, 45, 331-332. http://dx.doi.org/10.2169/internalmedicine.45.1643
[18] Javors, B.R., Baker, S.R. and Miller, J.A. (1999) The Northern Exposure Sign: A Newly Described Finding in Sigmoid Volvulus. AJR, 173, 571-574. http://dx.doi.org/10.2214/ajr.173.3.10470881
[19] Raveenthiran, V. (2000) Emptiness of the Left Iliac Fossa: A New Clinical Sign of Sigmoid Volvulus. Postgraduate Medical Journal, 76, 638-641. http://dx.doi.org/10.1136/pmj.76.900.638
[20] Jones, O., Srivastava, V. and Cochrane, R. (2010) Splenic Flexure Volvulus. BMJ Case Reports. http://dx.doi.org/10.1136/bcr.10.2009.2357
[21] Sachidanathan, C.K., Soehner, B. (1972) Volvulus of the Splenic Flexure of the Colon, Report of a Case and Review of the Literature. Diseases of the Colon & Rectum, 24, 466-469.
[22] Blumberg, N.A. (1958) Volvulus of the Splenic Flexure of the Colon: Report of a Case with a Review of the Literature. British Journal of Surgery, 46, 292-295. http://dx.doi.org/10.1002/bjs.18004619720
[23] McGarity, W.C., Bobo, W. and Haynes, C.D. (1966) Volvulus of the Splenic Flexure of the Colon: Report of Two Cases and Literature Review. American Surgery, 32, 425-430.
[24] Poppel, M.H., Zeitel, B.E. and Abrams, R.M. (1956) Volvulus of the Splenic Flexure. American Journal of Digestive Diseases, 1, 380-386. http://dx.doi.org/10.1007/BF02233468
[25] Wray Jr., R.C. and Wangensteen, S.L. (1971) Volvulus of the Splenic Flexure and Cecum. Surgery, 27, 351-352.

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.