CT Findings of Sigmoid Volvulus

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

doi:10.2214/ajr.09.2580

Cited by 116 publications

(58 citation statements)

References 15 publications

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“…The pathognomonic radiologic findings of volvulus were not present in our patient, although this may be explained by the fact that approximately 60% of sigmoid volvulus cases present with a U-shaped appearance in abdominal X-rays and around 75% of cases present with a bird-beak appearance in abdominal CT (16). It should be kept in mind that pre-existing thyroid megacolon may distort typical radiologic imaging of this condition.…”

Section: Discussioncontrasting

confidence: 51%

Sigmoid Volvulus In Myxedema Megacolon

Zelada

Huachin

Villena

2017

AACE Clinical Case Reports

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Objective: To report a case of myxedema megacolon complicated with sigmoid volvulus that was successfully managed with surgery and intensive thyroid hormone replacement therapy (THRT).Methods: The clinical presentation, laboratory and imaging results, treatment of the myxedema megacolon episode, and post-surgical evolution with THRT are presented.Results: We present the case of a 17-year-old woman with history of congenital hypothyroidism, chronic constipation, and irregular treatment with levothyroxine, who was admitted to the emergency room following 7 days of abdominal pain, nausea, and vomiting. She presented with marked abdominal distention and without bowel sounds. An abdominal computerized tomography scan showed a severe colon enlargement. Thyroid-stimulating hormone (TSH) was 222 µIU/mL, total thyroxine was <1 µg/dL, and total triiodothyronine was <40 ng/dL. Exploratory laparotomy was performed. Sigmoid volvulus was found and sigmoidectomy was performed. No evidence of colonic obstruction was found, but her clinical condition did not improve. After 1 month of mixed replacement therapy with levothyroxine 150 µg/day plus liothyronine 25 µg/day, intestinal movements were re-established and she was discharged asymptomatic with a TSH level of 0.15 µIU/mL.Conclusion: Myxedema megacolon is a rare clinical manifestation of hypothyroidism that, when complicated by sigmoid volvulus, is diagnostically and clinically challenging. History of constipation, thyroid disease, signs and symptoms of hypothyroidism, poor treatment compliance, or lack of improvement after abdominal surgery should raise suspicion to identify these patients due to the high risk of anesthetic and post-surgery complications. In our case, a dual combination of levothyroxine plus liothyronine resulted in clinical and biochemical recovery. (AACE Clinical Case Rep. 2017;3:e144-e147) Abbreviations: CH = congenital hypothyroidism; GI = gastrointestinal; GIT = gastrointestinal tract; IV = intravenously; NR = normal range; THRT = hormone replacement therapy; TSH = thyroid-stimulating hormone

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Section: Discussioncontrasting

confidence: 51%

Sigmoid Volvulus In Myxedema Megacolon

Zelada

Huachin

Villena

2017

AACE Clinical Case Reports

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“…The sigmoid is the most common site of colonic volvulus and accounts for 60-75% of all cases of colonic volvulus [9]. It occurs when sigmoid colon undergoes a twist along its mesenteric axis leading to a closed loop obstruction which predisposes to ischemia, perforation and death [7]. Sigmoid volvulus usually occurs in chronically ill, debilitated and institutionalized patients.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, nausea and vomiting could also be the presenting complaints [1][2][3][4][5][6][7][8][9]. On examination, abdominal tenderness, hyperkinetic or absent/hypokinetic bowel sounds and empty rectum are the usual signs [3].…”

Section: Discussionmentioning

confidence: 99%

“…On CT scan, swirling of the mesentery may be seen at the site of the volvulus [9]. Levsky et al described two imaging signs of volvulus: X-marks-the spot-sign in which crossing sigmoid transition is seen and the split wall sign in which the intestinal walls are separated by adjacent mesenteric fat planes due to partial twisting of the sigmoid loop [7,8].…”

Section: Discussionmentioning

confidence: 99%

“…The differential diagnosis for intestinal obstruction in pregnancy includes congenital or postoperative adhesions, volvulus, hernia, intussusception, malignancy and appendicitis [1,2,4,5]. Sigmoid volvulus is the most common cause of intestinal obstruction accounting for 25-44% of the reported cases in literature [1][2][3][4][5][6][7]. It is extremely important to diagnose this condition early as a delay in diagnosis can lead to maternal as well as fetal complications.…”

Section: Introductionmentioning

confidence: 99%

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Sigmoid volvulus during second trimester of pregnancy in a primigravida: Report of a rare case with review of imaging of sigmoid volvulus

Ashraf¹,

Peer²,

Fayaz³

et al. 2016

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Case Report: A case of 20-year-old female, primigravida, in 22nd week of pregnancy who presented to our hospital with a three-day history of colicky abdominal pain, few episodes of vomiting and obstipation. Ultrasound showed a single live intrauterine fetus and a dilated gut loop extending from left hypochondrium to the left iliac fossa. T2-weighted TRUFI and HASTE MR Images in axial and coronal plane showed radiological signs highly suggestive of sigmoid volvulus. The radiological findings were confirmed on laparotomy and detorsion of the sigmoid loop with decompression followed by sigmoidopexy was performed. No maternal or fetal complications occurred in the perioperative period. Conclusion: Sigmoid volvulus is a rare non-obstetric complication of pregnancy which requires an early diagnosis and prompt intervention to prevent maternal and fetal complications. Magnetic resonance imaging scan can provide an accurate diagnosis of sigmoid volvulus and its use is safe in pregnancy with respect to the risks of radiation exposure in pregnancy. IJCRI publishes

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