The terminal ileum usually twists with the cecum. A reasonable scanning protocol for a routine abdominal and pelvic CT with a 64-detector scanner would include the following acquisition parameters: helical mode, 120 kVp; beam pitch, 0.8–1.375; automated tube current modulation with minimum tube current, 100–150 mAs; reconstruction section thickness, 5 mm. Bowel sounds are usually hypoactive in patients with LBO; this is caused by the cessation of peristalsis (8). The more proximal colon volvuli occur due to a congenital defect in the cecum or transverse colon mesentery, which makes these segments of the colon more mobile and prone to twisting (40). (a) CT scout image shows dilated, air-filled colon and small bowel terminating in the left upper abdomen (arrow). Viewer, Splenic hematoma may present as large bowel obstruction: A case report, Imaging of Uncommon Causes of Large-Bowel Obstruction, Imaging of acute anorectal conditions with CT and MRI, Cross-Sectional and Nuclear Imaging as Part of Emergency Workup, Highly water-stable rare ternary Ag–Au–Se nanocomposites as long blood circulation time X-ray computed tomography contrast agents, Perforation of the cecum resulting from a closed-loop obstruction in a patient with an adenocarcinoma of the sigmoid colon: a case report, Colorectal cancer mimics: a review of the usual suspects with pathology correlation, Abdominal radiograph pearls and pitfalls for the emergency department radiologist: a pictorial review, Magnetic Resonance of Pelvic and Gastrointestinal Emergencies, A case of fatal sigmoid volvulus visualized on postmortem radiography: The importance of image optimization with multidetector computed tomography, Akute Kolonpseudoobstruktion: Ogilvie-Syndrom, Volvulus of the Gastrointestinal Tract: Appearances at Multimodality Imaging, Bowel Twists and Turns! The large bowel can rarely become obstructed from external compression. It is important to exclude malignancy in these individuals as the risk of colon cancer is two to three times higher in patients with Crohn disease compared with age-matched standard populations (75). Common causes of adynamic ileus include recent gastrointestinal surgery, recent opiate use, critical illness, neurologic disorders, and metabolic disturbances (19). The transverse colon volvulus is very uncommon, accounting for between 1%–4% of all colonic volvulus (5,54,55). Acute complete large-bowel obstruction (LBO) is an abdominal emergency, with high morbidity and mortality rates if left untreated (1,2). Anatomically, this represents a distended sigmoid colon resulting from the accumulation of hard stool. When the GI tract is not well, we can feel quite miserable with stomachache, vomiting, diarrhea or other symptoms, such as behavioral changes or problem behaviors. Accuracy of abdominal radiography in acute small-bowel obstruction: does reviewer experience matter? Many other lesions have been reported to cause intussusception, including gastrointestinal stromal tumors, as well as a variety of appendiceal lesions, including the inverted appendiceal stump, endometriosis involving the appendix, and benign masses such as a mucocele (65,66). Unlike in an adynamic ileus, perforation may occur with ACPO. cannot say in your particular case, but generally, if there isnt surgery, a burst bowel is often fatal. The water-soluble enema is a helpful diagnostic tool in the confirmation of sigmoid volvulus. Both upstream small bowel and large bowel are dilated. Figure 6b: Images in a 72-year-old woman with LBO caused by sigmoid volvulus. Cecal volvulus is characterized by twisting of the cecum causing a proximal LBO. The inverted U sign, an inverted ahaustral dilated sigmoid in the shape of an inverted “U” extending into the right upper quadrant, is specific to sigmoid volvulus and is seen in 25%–78% of patients (43,46) The northern exposure sign, also specific to sigmoid volvulus, describes the repositioning of the dilated sigmoid colon out of the pelvis to extend above the transverse colon (Fig 5); among a series of 30 cases of sigmoid volvulus, Javors et al (41) found this sign in 26 (87%) of the cases. A contrast enema will show extrinsic compression producing the LBO. Dr. Binderow continues, “CT is very good for solid organ disease — liver, spleen, kidneys. Ct with oral,iv&rectal contrast.all normal.severe ovulation & left colon pain with thin stool.wbc25,neutroph88.aft12day antibio wbc13& normal neutro?? Figure 9a: Images in a 47-year-old man with LBO caused by diverticulitis. ■ CT has become the standard imaging procedure for patients with both SBO and LBO. CT findings of cecal volvulus include marked distension of the cecum in an abnormal location, usually in the mid or left upper abdomen. Stricture formation and obstruction is less common in ulcerative colitis and should raise suspicion of an underlying malignancy. A moderate amount of stool in the left colon is normal, but a moderate to large amount of stool in the right colon is frequently a source for abdominal pain and/or peptic symptoms. In the setting of vascular compromise and ischemia, patients often demonstrate substantial abdominal tenderness. To learn more, please visit our. CT is extremely helpful in the diagnosis of sigmoid volvulus. The whirl sign can be found at the site of the twist. 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