Answer for BIR CoW 27 May 2018
Transverse colon volvulus
Findings:
Xray abdomen AP (erect) shows
Dilated peripheraly located large bowel loops with multiple air fluid levels seen in left upper quadrant.
Elevated left hemidiaphgram .
Collapsed small bowel loops.
CT abdomen axial and coronal section of the same patient shows
Dilated distal ileum ,caecum ,ascending colon and proximal trasverse colon noted
Twisting of transverse colon mesentry and colonic loop with distal collapsed descending and sigmoid colon.
Minimal free fluid noted in peritoneal cavity.
Discussion:
Types of volvulus
•Gastric
•Midgut
•colonic
Colonic Volvulus
•Caecal volvulus - 25%–40%
•Transverse colon volvulus – rarest .
•Sigmoid volvulus is the most common site of colonic volvulus and - 60%–75%.
•In CT , the abnormally positioned caecum located in the upper mid and left abdomen .
•At the level of obstruction, area of swirling of the bowel and its mesentery is seen - “whirl” sign .
Transverse Colon Volvulus
•The transverse colon volvulus is the rarest .(<5%–10% of cases), it is associated with the highest mortality.
• It occurs in the setting of abnormal fixation of a long transverse colon.
Diagnosis is made at CT by
•Level of bowel obstruction
•Classic mesenteric twist.
•Ascending colon is dilated in transverse colon volvulus.(In cecal volvulus , ascending colon will be collapsed).
•Sigmoid volvulus – northern exposure sign is displacement of the sigmoid colon above the transverse colon .
Findings:
Xray abdomen AP (erect) shows
Dilated peripheraly located large bowel loops with multiple air fluid levels seen in left upper quadrant.
Elevated left hemidiaphgram .
Collapsed small bowel loops.
CT abdomen axial and coronal section of the same patient shows
Dilated distal ileum ,caecum ,ascending colon and proximal trasverse colon noted
Twisting of transverse colon mesentry and colonic loop with distal collapsed descending and sigmoid colon.
Minimal free fluid noted in peritoneal cavity.
Discussion:
Types of volvulus
•Gastric
•Midgut
•colonic
Colonic Volvulus
•Caecal volvulus - 25%–40%
•Transverse colon volvulus – rarest .
•Sigmoid volvulus is the most common site of colonic volvulus and - 60%–75%.
•In CT , the abnormally positioned caecum located in the upper mid and left abdomen .
•At the level of obstruction, area of swirling of the bowel and its mesentery is seen - “whirl” sign .
Transverse Colon Volvulus
•The transverse colon volvulus is the rarest .(<5%–10% of cases), it is associated with the highest mortality.
• It occurs in the setting of abnormal fixation of a long transverse colon.
Diagnosis is made at CT by
•Level of bowel obstruction
•Classic mesenteric twist.
•Ascending colon is dilated in transverse colon volvulus.(In cecal volvulus , ascending colon will be collapsed).
•Sigmoid volvulus – northern exposure sign is displacement of the sigmoid colon above the transverse colon .
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!