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Flexible Colonoscopy in Mice to Evaluate the Severity of Colitis and Colorectal Tumors Using a Validated Endoscopic Scoring System

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Sigmoid volvulus-Can CT features predict outcomes and recurrence?

Brian M Moloney¹, Christine E Mc Carthy², Rajesh Bhayana¹

¹Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Canada.

European Radiology

|July 26, 2024

Summary

Sigmoid volvulus (SV) recurrence risk increases with colonic distension over 9cm. CT findings like ischemia predict surgical intervention, guiding management for this common bowel obstruction.

Keywords:

Colonic distension Recurrence Sigmoid volvulus Volvulus

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Area of Science:

Radiology
Gastroenterology
Surgical Oncology

Background:

Sigmoid volvulus (SV) is a frequent cause of bowel obstruction, particularly in elderly individuals.
SV can manifest as mesenteroaxial (M-SV) or organoaxial (O-SV) types.

Purpose of the Study:

To determine if computed tomography (CT) findings in sigmoid volvulus correlate with clinical outcomes.
To assess the association between CT features and recurrence, management choices, and mortality in SV patients.

Main Methods:

Analysis of CT scans from 80 patients diagnosed with SV within 24 hours of presentation.
Evaluation of CT features including volvulus arrangement, rotation, transition points, distension, whirl-sign, ischemia, and perforation.
Correlation of imaging findings with demographic data, treatment, recurrence, and mortality.

Main Results:

M-SV and O-SV were equally prevalent. Anticlockwise axial and clockwise coronal rotation were significantly more common in M-SV.
Patients with CT evidence of ischemia universally underwent surgery.
Colonic distension of 9 cm or more on initial CT was a significant predictor of recurrence (OR: 3.23; 95% CI: 1.39-7.92).

Conclusions:

Baseline colonic distension exceeding 9 cm on CT is linked to a higher risk of sigmoid volvulus recurrence.
CT findings indicating ischemia are predictive of surgical intervention over endoscopic management.
No significant differences in outcomes or management choices were observed between M-SV and O-SV subtypes.