Volvulus is defined as the twisting of a loop of bowel on its mesentery. The sigmoid colon, and less frequently, the cecum, are the common sites of volvulus in adults. - Patients typically show features of bowel obstruction (abdominal pain, distension, bilious vomiting)
Work-up follows the same protocol as that for bowel obstruction.Â
Abdominal x-ray (erect and supine)
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Sigmoid volvulus: coffee bean sign: dilated loop of sigmoid colon with absent haustrae; Absence of air in the rectum
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Cecal volvulus: dilated loop of cecum with maintained haustrae.; The colon distal to the obstruction does not dilateÂ
Barium enema :
bird beak sign (tapering of the dye column at the site of the twist) Â
- Sigmoid volvulus: Bird’s beak sign at the sigmoid; dye does not enter the sigmoid colon.
- Cecal volvulus: Bird’s beak sign at the cecum; dye does not enter the small bowel
