E1168. Twists and Turns in Acute Abdomen: Imaging Spectrum of Torsions and Volvulus Encountered in the Emergency Department-Common, Rare and Exotic
UT Health San Antonio
St. Vincent Medical Center
Ohio State University Wexner Medical Center
Torsion and Volvulus are relatively rare but can result in significant morbidity and mortality. Imaging plays a vital role in the management of these emergencies by identifying the condition and also aids in the detection of complications. The purpose of this exhibit is to provide a detailed review of a wide spectrum of torsion and volvulus that can present to the emergency department and to discuss the role of imaging, particularly multidetector computed tomography (MDCT) in the evaluation of these patients.
Educational Goals / Teaching Points
1. To describe the imaging manifestations of twists and turns in the abdomen and discuss the clinical manifestations of specific imaging findings.
2. To discuss the diagnostic strategy in patients with suspected torsion and volvulus.
3. To discuss the role of imaging in the management of these patients.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Torsion and volvulus usually present clinically as an emergency and require early and accurate diagnosis for prompt treatment. These include GI volvulus (gastric, midgut, cecal and sigmoid volvulus), ovarian and tubal torsion as well as extremely rare intra-abdominal testicular neoplastic torsion. MDCT is both highly sensitive and specific in the detection of torsion and volvulus and is well suited for reliable depiction of the underlying cause and associated complications.
Imaging plays a key role in the evaluation of patients presenting with torsion and volvulus. Knowledge of various entities and their imaging features can help the emergency radiologist to promptly triage the patients, thereby facilitating appropriate management.