J Korean Radiol Soc.  1988 Aug;24(4):615-624. 10.3348/jkrs.1988.24.4.615.

The plain film roentgenographic findings in diagnosis of intestinal volvulus

• Chung GH
• Seo YH
• Sohn SW
• Kim CS
• Choi KC
• Jeon DS

• KMID: 2359250
• DOI: http://doi.org/10.3348/jkrs.1988.24.4.615

Abstract

Intestinal volvulus indicates the twisting of a loop of bowel around the axis of its own mesentery and impliesinterference of the blood supply associated with the obstruction. It is the purpose of this communication toreview the clinical and plain roentgen manifestation on the basis of which the diagnosis can be established. Inthis regard, the authors have reviewed 60 cases of intestinal volvulus which have been treated from Jan, 1976 toDec, 1987 at Chunbuk National University and Chnju prebyterian Medical Center. The results were as follows: 1) Themost frequent type of intestinal volvulus was volvulus of small intestine(50%), followed by sigmoid volvulus(40%), compound volvulus (5%), cecal volvulus (3.3%) and transverse colon volvulus(1.7%). 2) The sex distributionof intestinal volvulus assumed a male to female ratio of 2.9 :1. The incidence ratio of male to female was 3.4:1in the volvulus of small intestine, 1.67:1 in sigmoid volvulus. All patients with cecal volvulus, compoundvolvulus, and transverse volvulus were male. 3) Of the age distribution, the youngest case was an infant of 8months, the oldest one in 79 years. There happened even age distribution in the volvulus of small intestine at anyage group, and old age distribution in colon volvulus. 4) In 30 cases of the volvulus of small intestine, thepredisposing factors were previous abdomianl operation in 20 cases (66.7%), congenital band in 3 cases (10%),malrotation in 3 cases (10%), tumor in 1 case(3.3%), and Meckel's diverticulum in 1 case(3.3%). In 24 cases ofsigmoid volvulus, the predisposing factors were redundant mobile bowel in 18 cases (75%), previous operation in 4cases (16.7%), and pelvic inflammation and adhesion in 2 cases (8.4%). In 2 cases of cecal volvulus, 1 case hadthe history of previous operation, and 1 case had long redundant cecal loop. In 3 cases of compound volvulus, 2cases had redundant mobile sigmoid, and 1 case had previous operation. 5) In 30 cases of the volvulus of smallintestine, the finding of the simple plain abdomen showed unusual ectopic position of small bowel, interlocking ofloop in ercet view, radiating stripes converging toward the the center of the torsion, disarrangement of dilatedloop in ercet film, fixation of the dilated loop and long fluid level, and intramural gas. In 24 cases of thesigmoid volvulus, the findings of simple plain abdomen showed inverted U shaped shadow & midline crease(typicalbend inner sign), single dilated without midline crease, and upright U shaped shadow with midline crease. In 2cases of cecal volvulus, the finding of ectopic position of cecum with dilatation and distended small bowel withfluid level. In the 3 cases of compound volvulus, the findings of dilatation of sigmoid colon with displacement tothe right side of the abdome, the presence of dilated small bowel loop in the left lower abdomen, and dilatedsigmoid with tapering off-shoot around the encircling ileal loop ( signet-ring appearance).

MeSH Terms

Abdomen
Age Distribution
Causality
Cecum
Colon
Colon, Sigmoid
Colon, Transverse
Diagnosis*
Dilatation
Female
Humans
Incidence
Infant
Inflammation
Intestinal Volvulus*
Intestine, Small
Male
Meckel Diverticulum
Mesentery