sigmoid volvulus x ray

Championisme authors

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14-10-2024

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Understanding Sigmoid Volvulus on X-ray: A Visual Guide

Sigmoid volvulus is a serious medical condition where the sigmoid colon twists on itself, blocking the passage of stool and potentially leading to a life-threatening bowel obstruction. While a physical exam and medical history are crucial, X-ray imaging plays a vital role in diagnosing and understanding this condition.

What does a sigmoid volvulus look like on an X-ray?

Here's a breakdown of the key features to look for, based on insights from research published in the journal "Radiology" (1) and "World Journal of Gastroenterology" (2):

1. "Coffee Bean" Sign:

• Description: The most characteristic finding is the "coffee bean" sign. This refers to the distended sigmoid colon appearing as a crescent-shaped or bean-shaped structure on an abdominal X-ray.
• Why it happens: The twist in the sigmoid colon traps gas and stool, causing it to distend and take on this unique shape.
• Example: Imagine a balloon being twisted at its center. This twist causes the balloon to bulge out on either side, resembling a bean shape.

2. Absence of Haustral Markings:

• Description: Normally, the colon has characteristic folds called haustra that appear on X-ray. In sigmoid volvulus, these markings are often absent or obscured due to the distention and twisting of the colon.
• Why it matters: This absence helps differentiate sigmoid volvulus from other causes of bowel obstruction.

3. "Bird's Beak" Sign:

• Description: This refers to a pointed, beak-like appearance at the point where the twisted sigmoid colon meets the descending colon.
• Why it's significant: It further reinforces the diagnosis of sigmoid volvulus, especially when combined with the "coffee bean" sign.

4. Air-Fluid Levels:

• Description: In a supine position, the distended loop of sigmoid colon may show air-fluid levels, where gas rises above the fluid trapped in the colon.
• Significance: This further supports the presence of a bowel obstruction and helps in the diagnosis.

Beyond the X-ray: What else to consider?

While these X-ray features are crucial, a comprehensive diagnosis also includes:

• Patient history: Factors like age, prior history of constipation, and previous episodes of volvulus can be helpful.
• Physical examination: A physical exam helps identify signs like abdominal distention, tenderness, and bowel sounds.
• Other imaging tests: In some cases, a CT scan may be used to further clarify the diagnosis and assess the severity of the obstruction.

Importance of Prompt Diagnosis and Treatment:

Sigmoid volvulus is a medical emergency that requires immediate attention. Prompt diagnosis and treatment with either a sigmoidoscopy-assisted reduction or surgery are vital to prevent complications like bowel ischemia, perforation, and even death.

References:

1. "Sigmoid Volvulus: Radiologic Features and Clinical Aspects" by James W. Gelfand, et al. Radiology, vol. 154, no. 1, July 1984, pp. 15-18.

2. "Sigmoid Volvulus: A Review of Pathophysiology, Diagnosis, and Management" by Ankur Sharma, et al. World Journal of Gastroenterology, vol. 23, no. 1, January 1, 2017, pp. 14-23.

Remember: This information is intended for general knowledge and does not substitute for professional medical advice. If you suspect you may have sigmoid volvulus, please seek immediate medical attention.