DDX of volvulus

Approach to the DDX of volvulus:

  • Gastric volvulus is diagnosed by abnormal position of parts of the stomach in the left upper quadrant
  • In the clinical setting of bilious vomiting, an upper GI should be performed emergently to rule out malrotation with midgut volvulus so if it is discovered it can be corrected via surgery immediately
  • The incidental discovery of malrotation without midgut volvulus is not a surgical emergency and can be corrected electively
  • Occasionally in patients with malrotation without midgut volvulus, chronic volvulus can be encountered in the operating room, manifested by chronic dilation of the mesenteric lymphatic and venous systems
  • Cecal volvulus is diagnosed by enema in patients with distal small bowel obstruction who cannot have contrast refluxed into the cecum
  • Sigmoid volvulus is diagnosed by enema in patients with distal colonic obstruction (coffee bean sign) who cannot have contrast refluxed into the descending colon
  • A small bowel or mesenteric cystic lesion or adhesion can serve as a lead point for a small bowel volvulus around it which can demonstrate a whirlpool sign