Cecal volvulus: Imaging features

Abstract

ObjectiveTo determine the sensitivity of plain film radiography and computed tomography (CT) in the diagnosis of cecal volvulus. Material and methodsWe reviewed the clinical histories of 11 patients diagnosed with cecal volvulus at endoscopy or surgery. In consensus, two radiologists analyzed the imaging findings on plain film radiography and CT and calculated the sensitivities. The plain film and CT studies were retrospectively classified as certain, probable, or indeterminate for cecal volvulus on the basis of the presence or absence of previously reported signs. Signs of wall compromise at CT were compared with the histologic findings. ResultsThe most sensitive findings on plain film radiography were the presence of a disproportionately dilated bowel loop and a pattern of distal small bowel obstruction (91%), followed by a single air-fluid level in the cecum and collapse of the distal colon (82%). At CT, the coffee bean sign with a single air-fluid level and collapse of the left colon had a sensitivity of 100%. The whirl sign was present in 86% of cases. Retrospectively, 36% of the plain film radiographs and 86% of the CT studies were correctly classified as positive for cecal volvulus. Although all cases with ischemia had signs of vascular compromise on CT, no significant correlation was observed between these variables. ConclusionsThe signs reported in the literature for cecal volvulus enable a certain diagnosis on plain film radiography in one third of all cases, while on CT, they allow this diagnosis in most cases The evaluation of additional findings increases the chances of reaching the correct diagnosis.