COLONIC

VOLVULUS Disusun oleh:

Dhea Faizia Tasya (2110221036)
Pembimbing:
Dr. Yulia Rachmawati, Sp. Rad (K)

KEPANITERAAN KLINIK RADIOLOGI

RSPAD GATOT SOEBROTO
FAKULTAS KEDOKTERAN UPN VETERAN JAKARTA
2021
 DEFINISI

• Torsion or twisting of redundant

segment of colon around its
mesentery
• Colonic volvulus, third most
common cause of colonic
obstruction worldwide, after
colorectal cancer and complicated
sigmoid diverticulitis

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
 Intestinal volvulus
Sigmoid volvulus
Cecal volvulus
Colon volvulus

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
 TYPES

Sigmoid Cecal
01 60-75% of cases
02 25-40% of cases

Transverse Splenic flexure

03 1-4% of cases
04 <1% of cases

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
 EPIDEMIOLOGI

• Colonic volvulus paling sering terjadi pada colon sigmoid atau

cecum

Sigmoid volvulus
• Usia 30-39 tahun
Cecal volvulus
• Wanita : pria = 4 : 1
• Wanita ≤ 60 tahun
• Pasien dengan diabetes
• Wanita hamil (1% kasus cecal
• Pasien dengan gangguan neuropsikiatri
volvulus)
• Wanita hamil
• Jarang pada infants dan anak-anak

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
 FAKTOR RISIKO

• Konstipasi kronik
• Dismotilitas kolon
• Riwayat operasi abdominal  laparotomi
• Riwayat episode volvulus
• High-fiber diet
• Frequent use of laxatives

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
 ETIOLOGI

• Colonic volvulus typically

results from torsion of a
redundant segment of colon
along its mesenteric axis,
occurring mostly commonly
in sigmoid colon or cecum

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
 MANIFESTASI KLINIS

• Distensi abdomen
• Nyeri abdomen Gejala sigmoid volvulus
• Lower abdominal cramping • Asymmetric gaseous abdominal
• Konstipasi distention associated with emptiness of
• Obstipation left iliac fossa
• Nausea, vomiting

Gejala cecal volvulus

Gejala pada anak-anak • Intermittent and/or spontaneously
• Recurrent abdominal pain and bloody resolve and recur, or
stools • Present acutely if intestinal obstruction

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
 PEMERIKSAAN FISIK
General Physical Rectal
• KU, kesadaran, dan TTV • Feces +/-
• Diaphoresis, hipotensi, takikardi, • Darah +/-
demam

Abdomen
• Peristalsis +/-
• Palpable abdominal mass
• BU abnormal
• Distensi

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
Atamanalp, S., 2010. Sigmoid Volvulus. The Eurasian Journal of Medicine, 42(3), pp.142-147.
Mizumoto, J., 2021. Coffee Bean Sign Detected By Visual Inspection. The American Journal of Medicine, 134(6), pp.e388-e389.
 PEMERIKSAAN PENUNJANG

Blood Test
Imaging Studies
- Darah lengkap
• Foto polos abdominal (AXR)
- Kadar elektrolit serum
• CT or contrast enema imaging
- Test fungsi renal

Endoscopy
Untuk menilai viabilitas colon, jika pada
imaging perforasi (-) atau iskemia (-)

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
 ABDOMINAL X-RAY OF SIGMOID VOLVULUS

• large dilated loop of colon typically with air-fluid levels

• 'coffee bean' sign
• absence of rectal gas
DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
 ABDOMINAL X-RAY OF SIGMOID VOLVULUS

Herring, W., 2019. Learning radiology.

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
 ABDOMINAL X-RAY OF CECAL VOLVULUS

• distention of loop of large bowel with long

axis extended from right lower quadrant to
epigastrium or left upper quadrant
• single air-fluid level
• cecal and small bowel dilation may be evident

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
ABDOMINAL X-RAY OF CECAL VOLVULUS
ABDOMINAL X-RAY OF CECAL
VOLVULUS
 BARIUM ENEMA OF SIGMOID VOLVULUS

• typical “bird’s beak” appearance at the site of obstruction in sigmoid volvulus

Patel, P., 2010. Radiology. West Sussex: Wiley-Blackwell.
DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
BARIUM ENEMA OF CECAL VOLVULUS
 CT OF COLONIC VOLVULUS

• “whirl sign”

Chen MYM, Pope TL, Ott DJ. Basic radiology. New York: Lange Medical Books/McGraw Hill, 2004.
 MANAGEMENT

Initial supportive management

• IV fluid Sigmoid Volvulus
Non surgical
• Dekompresi dengan sigmoidoskopi fleksibel
Cecal Volculus dan memasukkan rectal tube past obstruction
Non surgical Surgical
• Detorsi dan dekompresi • Reseksi dan/atau anastomosis primer
kolonoskopi • Indikasi: strangulasi, perforasi, atau
Surgical dekompresi dengan endoskopi yang gagal
• Right colectomy + ileotransvrse
colonic anastomosis

TRAN, C., CHEN, Y. A., SHAH, R., & VAISMAN, A. (2020). The Toronto notes 2020: comprehensive medical reference and review for the Medical Council of
Canada Qualifying Exam Part 1 and the United States Medical Licensing Exam Step 2. Toronto, Toronto Notes for Medical Students, Inc.
 Suspect gangrene
Suspect colon ischemia • Hipotensi dan syok
• Sudden cramping • Hematokezia atau BAB berdarah
• Nyeri ringan di LLQ merah
• Urgent desire to defecate • Demam
• Bright red or maroon blood in • Leukositosis
stool in last 24 hours • Nyeri tekan abdomen
• Bloody diarrhea • Somnolen
• Metabolic acidosis

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
 PROGNOSIS

• SV memiliki prognosis yang baik

• Mortalitas : 50%  10%
• Adanya syok, bowel gangrene, perforasi kolon, komorbiditas, usia tua,
dan emergency surgery meningkatkan mortality rate
• Morbiditas : 6 – 24%

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
THANK YOU
 DAFTAR PUSTAKA

1. DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record

No. T115668, Colonic Volvulus; [updated 2018 Nov 30, cited place cited date here]. Available
from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
2. Atamanalp, S., 2010. Sigmoid Volvulus. The Eurasian Journal of Medicine, 42(3), pp.142-147.
3. Mizumoto, J., 2021. Coffee Bean Sign Detected By Visual Inspection. The American Journal of
Medicine, 134(6), pp.e388-e389.
4. Herring, W., 2019. Learning radiology.
5. Patel, P., 2010. Radiology. West Sussex: Wiley-Blackwell.
6. Chen MYM, Pope TL, Ott DJ. Basic radiology. New York: Lange Medical Books/McGraw Hill,
2004.
7. TRAN, C., CHEN, Y. A., SHAH, R., & VAISMAN, A. (2020). The Toronto notes 2020: comprehensive
medical reference and review for the Medical Council of Canada Qualifying Exam Part 1 and the
United States Medical Licensing Exam Step 2. Toronto, Toronto Notes for Medical Students, Inc.
 MANAGEMENT

• Resusitasi cairan  fluid-electrolyte imbalance, nasogastric aspiration, dan

parenteral feeding
• Flexible endoscopic detorsion  tingkat kesuksesan 33 – 91%
• Emergency surgery pada pasien dengan peritonitis, bowel gangrene, atau
perforasi
• Detorsion, sigmoidopexy, mesosigmoidoplasty, or sigmoid resection with
primary anastomosis or stoma
• After the resection of gangrenous segment, Hartmann's or Mikuliez procedures
• Endoscopic decompression is the usual treatment for a sigmoid volvulus.
• Sigmoid colectomy may be used to reduce or prevent recurrent volvulus.

Herring, W., n.d. Learning radiology.

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.