Purpose or Case Report: Colonic volvulus is an uncommon but often catastrophic condition in children. Imaging studies including plain radiographs, ultrasound, fluoroscopy, and computed tomography are commonly employed to evaluate these patients. While most radiologists are familiar with malrotation and midgut volvulus, colonic volvulus is an underappreciated cause of an acute abdomen in children. Symptoms of colonic volvulus may be vague, and presentation is often delayed. While plain radiographs may be highly suggestive in some patients, they are often nonspecific. Fluoroscopy and CT are usually diagnostic and can direct appropriate operative management. The purpose of this exhibit is to present the imaging appearances of cecal and sigmoid volvulus in children, emphasizing the plain radiographic features suggestive of these entities and the diagnostic fluoroscopic and CT features that allow definitive diagnosis.
Methods & Materials: The "coffee bean" sign of colonic volvulus on plain radiographs will be demonstrated, as well as its location in order to distinguish between sigmoid and cecal volvulus. Fluoroscopic features of sigmoid volvulus, emphasizing the "beak" sign, will be shown. CT features of cecal and sigmoid volvulus, emphasizing the "whirlpool" sign, will be presented and discussed.
Results: Cecal volvulus is rare and comprises 25%–40% of all volvulus involving the colon. Plain radiographs may show the classic “coffee bean" sign of markedly dilated cecum within the left upper quadrant. CT shows twisting of colon at the junction of cecum and ascending colon, with displacement of the dilated cecum into either the left upper or lower quadrants. Urgent surgical correction is warranted. Sigmoid volvulus is slightly more common than cecal volvulus, though still rare. Sigmoid volvulus is a true emergency, requiring early recognition and treatment. Plain films may demonstrate the "coffee bean" sign, with dilated sigmoid colon proximal to the volvulus displaced into the right upper quadrant. Fluoroscopy shows a "beak" sign at the point of volvulus, and CT demonstrates a "whirlpool" sign within the medial left abdomen. A combination of emergent rectal tube decompression and sigmoid resection is the usual management.
Conclusions: Volvulus of the cecum or sigmoid colon may present as an acute abdomen in children. Plain radiographs may be suggestive, and definitive diagnosis may be made with contrast enema or CT. Prompt and accurate imaging diagnosis is paramount for appropriate management of these patients.