CT findings of sigmoid volvulus

Jeffrey M. Levsky, Elana I. Den, Ronelle A. DuBrow, Ellen L. Wolf, Alla Rozenblit

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this study was to evaluate the features of sigmoid volvulus on CT scanograms and cross-sectional images. MATERIALS AND METHODS. We retrospectively reviewed 21 cases of sigmoid volvulus in 15 men and six women. Three radiologists evaluated scanograms and cross-sectional images for several classic and two novel imaging signs of volvulus: crossing sigmoid transitions (called the X-marks-the-spot sign) and folding of the sigmoid wall by partial twisting (called the split-wall sign). A general impression was assigned to scanograms and cross-sectional images. CT findings suggesting bowel compromise were compared with pathologic and endoscopic findings. RESULTS. The most sensitive scanogram findings were absence of rectal gas (19 of 21 cases, 90%) and an inverted-U-shaped distended sigmoid (18 of 21 cases, 86%) followed by the coffee bean sign and disproportionate sigmoid enlargement (both 16 of 21 cases, 76%). The most sensitive cross-sectional findings were one sigmoid colon transition point (20 of 21 cases, 95%) and disproportionate enlargement of the sigmoid (18 of 21 cases, 86%). The X-marks-the-spot and split-wall signs were present in nine of 21 (43%) and 11 of 21 (52%) patients, but one of the two signs was present in 18 of 21 patients (86%). Classic radiographic and definitive cross-sectional findings were seen in 11 of 21 (52%) and 16 of 21 (76%) patients. CT findings were definitive in five of seven patients (71%) with indeterminate scanogram findings. Imaging signs suggesting bowel compromise correlated poorly with clinical ischemia, but CT features were present in all three patients with frank necrosis. CONCLUSION. Sigmoid volvulus has a spectrum of imaging findings. A classic appearance is absent on approximately one half of scanograms and one fourth of CT scans. Use of new signs that model the pathophysiologic characteristics of volvulus (X-marks-the-spot sign for more complete twisting and split-wall sign for less severe twisting) may improve diagnostic confidence.

Original languageEnglish (US)
Pages (from-to)136-143
Number of pages8
JournalAmerican Journal of Roentgenology
Volume194
Issue number1
DOIs
StatePublished - Jan 2010

Fingerprint

Intestinal Volvulus
Sigmoid Colon
Coffee
Necrosis
Ischemia
Gases

Keywords

  • CT
  • Sigmoid volvulus

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Levsky, J. M., Den, E. I., DuBrow, R. A., Wolf, E. L., & Rozenblit, A. (2010). CT findings of sigmoid volvulus. American Journal of Roentgenology, 194(1), 136-143. https://doi.org/10.2214/AJR.09.2580

CT findings of sigmoid volvulus. / Levsky, Jeffrey M.; Den, Elana I.; DuBrow, Ronelle A.; Wolf, Ellen L.; Rozenblit, Alla.

In: American Journal of Roentgenology, Vol. 194, No. 1, 01.2010, p. 136-143.

Research output: Contribution to journalArticle

Levsky, JM, Den, EI, DuBrow, RA, Wolf, EL & Rozenblit, A 2010, 'CT findings of sigmoid volvulus', American Journal of Roentgenology, vol. 194, no. 1, pp. 136-143. https://doi.org/10.2214/AJR.09.2580
Levsky JM, Den EI, DuBrow RA, Wolf EL, Rozenblit A. CT findings of sigmoid volvulus. American Journal of Roentgenology. 2010 Jan;194(1):136-143. https://doi.org/10.2214/AJR.09.2580
Levsky, Jeffrey M. ; Den, Elana I. ; DuBrow, Ronelle A. ; Wolf, Ellen L. ; Rozenblit, Alla. / CT findings of sigmoid volvulus. In: American Journal of Roentgenology. 2010 ; Vol. 194, No. 1. pp. 136-143.
@article{afa68e052ddf466e9f1aa312ea2be297,
title = "CT findings of sigmoid volvulus",
abstract = "OBJECTIVE. The purpose of this study was to evaluate the features of sigmoid volvulus on CT scanograms and cross-sectional images. MATERIALS AND METHODS. We retrospectively reviewed 21 cases of sigmoid volvulus in 15 men and six women. Three radiologists evaluated scanograms and cross-sectional images for several classic and two novel imaging signs of volvulus: crossing sigmoid transitions (called the X-marks-the-spot sign) and folding of the sigmoid wall by partial twisting (called the split-wall sign). A general impression was assigned to scanograms and cross-sectional images. CT findings suggesting bowel compromise were compared with pathologic and endoscopic findings. RESULTS. The most sensitive scanogram findings were absence of rectal gas (19 of 21 cases, 90{\%}) and an inverted-U-shaped distended sigmoid (18 of 21 cases, 86{\%}) followed by the coffee bean sign and disproportionate sigmoid enlargement (both 16 of 21 cases, 76{\%}). The most sensitive cross-sectional findings were one sigmoid colon transition point (20 of 21 cases, 95{\%}) and disproportionate enlargement of the sigmoid (18 of 21 cases, 86{\%}). The X-marks-the-spot and split-wall signs were present in nine of 21 (43{\%}) and 11 of 21 (52{\%}) patients, but one of the two signs was present in 18 of 21 patients (86{\%}). Classic radiographic and definitive cross-sectional findings were seen in 11 of 21 (52{\%}) and 16 of 21 (76{\%}) patients. CT findings were definitive in five of seven patients (71{\%}) with indeterminate scanogram findings. Imaging signs suggesting bowel compromise correlated poorly with clinical ischemia, but CT features were present in all three patients with frank necrosis. CONCLUSION. Sigmoid volvulus has a spectrum of imaging findings. A classic appearance is absent on approximately one half of scanograms and one fourth of CT scans. Use of new signs that model the pathophysiologic characteristics of volvulus (X-marks-the-spot sign for more complete twisting and split-wall sign for less severe twisting) may improve diagnostic confidence.",
keywords = "CT, Sigmoid volvulus",
author = "Levsky, {Jeffrey M.} and Den, {Elana I.} and DuBrow, {Ronelle A.} and Wolf, {Ellen L.} and Alla Rozenblit",
year = "2010",
month = "1",
doi = "10.2214/AJR.09.2580",
language = "English (US)",
volume = "194",
pages = "136--143",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
publisher = "American Roentgen Ray Society",
number = "1",

}

TY - JOUR

T1 - CT findings of sigmoid volvulus

AU - Levsky, Jeffrey M.

AU - Den, Elana I.

AU - DuBrow, Ronelle A.

AU - Wolf, Ellen L.

AU - Rozenblit, Alla

PY - 2010/1

Y1 - 2010/1

N2 - OBJECTIVE. The purpose of this study was to evaluate the features of sigmoid volvulus on CT scanograms and cross-sectional images. MATERIALS AND METHODS. We retrospectively reviewed 21 cases of sigmoid volvulus in 15 men and six women. Three radiologists evaluated scanograms and cross-sectional images for several classic and two novel imaging signs of volvulus: crossing sigmoid transitions (called the X-marks-the-spot sign) and folding of the sigmoid wall by partial twisting (called the split-wall sign). A general impression was assigned to scanograms and cross-sectional images. CT findings suggesting bowel compromise were compared with pathologic and endoscopic findings. RESULTS. The most sensitive scanogram findings were absence of rectal gas (19 of 21 cases, 90%) and an inverted-U-shaped distended sigmoid (18 of 21 cases, 86%) followed by the coffee bean sign and disproportionate sigmoid enlargement (both 16 of 21 cases, 76%). The most sensitive cross-sectional findings were one sigmoid colon transition point (20 of 21 cases, 95%) and disproportionate enlargement of the sigmoid (18 of 21 cases, 86%). The X-marks-the-spot and split-wall signs were present in nine of 21 (43%) and 11 of 21 (52%) patients, but one of the two signs was present in 18 of 21 patients (86%). Classic radiographic and definitive cross-sectional findings were seen in 11 of 21 (52%) and 16 of 21 (76%) patients. CT findings were definitive in five of seven patients (71%) with indeterminate scanogram findings. Imaging signs suggesting bowel compromise correlated poorly with clinical ischemia, but CT features were present in all three patients with frank necrosis. CONCLUSION. Sigmoid volvulus has a spectrum of imaging findings. A classic appearance is absent on approximately one half of scanograms and one fourth of CT scans. Use of new signs that model the pathophysiologic characteristics of volvulus (X-marks-the-spot sign for more complete twisting and split-wall sign for less severe twisting) may improve diagnostic confidence.

AB - OBJECTIVE. The purpose of this study was to evaluate the features of sigmoid volvulus on CT scanograms and cross-sectional images. MATERIALS AND METHODS. We retrospectively reviewed 21 cases of sigmoid volvulus in 15 men and six women. Three radiologists evaluated scanograms and cross-sectional images for several classic and two novel imaging signs of volvulus: crossing sigmoid transitions (called the X-marks-the-spot sign) and folding of the sigmoid wall by partial twisting (called the split-wall sign). A general impression was assigned to scanograms and cross-sectional images. CT findings suggesting bowel compromise were compared with pathologic and endoscopic findings. RESULTS. The most sensitive scanogram findings were absence of rectal gas (19 of 21 cases, 90%) and an inverted-U-shaped distended sigmoid (18 of 21 cases, 86%) followed by the coffee bean sign and disproportionate sigmoid enlargement (both 16 of 21 cases, 76%). The most sensitive cross-sectional findings were one sigmoid colon transition point (20 of 21 cases, 95%) and disproportionate enlargement of the sigmoid (18 of 21 cases, 86%). The X-marks-the-spot and split-wall signs were present in nine of 21 (43%) and 11 of 21 (52%) patients, but one of the two signs was present in 18 of 21 patients (86%). Classic radiographic and definitive cross-sectional findings were seen in 11 of 21 (52%) and 16 of 21 (76%) patients. CT findings were definitive in five of seven patients (71%) with indeterminate scanogram findings. Imaging signs suggesting bowel compromise correlated poorly with clinical ischemia, but CT features were present in all three patients with frank necrosis. CONCLUSION. Sigmoid volvulus has a spectrum of imaging findings. A classic appearance is absent on approximately one half of scanograms and one fourth of CT scans. Use of new signs that model the pathophysiologic characteristics of volvulus (X-marks-the-spot sign for more complete twisting and split-wall sign for less severe twisting) may improve diagnostic confidence.

KW - CT

KW - Sigmoid volvulus

UR - http://www.scopus.com/inward/record.url?scp=74749097467&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=74749097467&partnerID=8YFLogxK

U2 - 10.2214/AJR.09.2580

DO - 10.2214/AJR.09.2580

M3 - Article

C2 - 20028915

AN - SCOPUS:74749097467

VL - 194

SP - 136

EP - 143

JO - American Journal of Roentgenology

JF - American Journal of Roentgenology

SN - 0361-803X

IS - 1

ER -