Volvulus of the Gastrointestinal Tract: Appearances at Multimodality Imaging

Abstract

Volvulus of the gastrointestinal tract, a clinically relevant cause of acute or recurring abdominal pain in adults, remains a diagnostic dilemma for radiologists in a large number of cases. The clinical symptoms associated with volvulus are often nonspecific and include pain and nausea with vomiting. Yet referring clinicians often rely on radiologists to make the diagnosis; volvulus is rarely diagnosed clinically. Radiography, fluoroscopy, and computed tomography are the imaging methods most often used for this purpose. Prompt diagnosis is critical to avoid life-threatening complications such as bowel ischemia and infarction. Thus, it is useful for radiologists to be familiar with the various appearances of volvulus throughout the gastrointestinal tract.

Acute mesenteroaxial gastric volvulus on computed tomography

“…[1,4,5] Gastric volvulus can be classified based on axis of rotation, severity (acute or chronic), extent (total or partial) or aetiology (primary or idiopathic). [6] The most frequently used classification system describes 3 types of gastric volvulus: organoaxial, mesenteroaxial and combination-unclassified.…”

“…4). [1,6] The greater curvature is displaced superiorly, and the lesser curvature lies more caudally in the abdomen. If the twist is >180 o , gastric outlet obstruction occurs.…”

“…[7] One of the predisposing factors for volvulus is the presence of a diaphragmatic defect; in adults, organoaxial volvulus occurs commonly in the setting of a post-traumatic diaphragmatic defect or a para-oesophageal hernia. [1,6] Another predisposing factor for volvulus is the presence of an abnormality relating to the anchoring of the stomach and the surrounding ligaments. [6] This is thought to be one predisposing factor in the development of the second type of volvulus, and the variant encountered in our patient -mesenteroaxial volvulus.…”

“…The imaging diagnosis also remains challenging. [1] Abdominal computed tomography (CT) has been underutilised in the diagnosis of gastric volvulus in previously reported series. [2] The present case illustrates the value and importance of abdominal CT in the rapid diagnosis of acute abdominal pathology and, in particular, acute gastric volvulus.…”

Endoscopic view in a patient with acute gastric volvulus

“…The antrum rotates anterosuperiorly and the fundus rotates posteroinferiorly. Strangulation of the stomach is relatively common in this type of volvulus (up to 30 % of cases) [3]. In mesenteroaxial volvulus, the stomach rotates around its short axis through a perpendicular line connecting the greater and lesser curvatures, and the antrum becomes displaced above the gastroesophageal junction.…”