Volvulus Types — Imaging Signs and Management
| Type | Imaging Signs | Notes |
|---|---|---|
| Sigmoid volvulus | Massively dilated inverted U-shaped sigmoid loop; apex points to RUQ; "coffee bean" or "bent inner tube" sign on XR; convergence of walls at left pelvis (twist site); loss of haustra; CT: whirl sign at twist, beak sign, dilated sigmoid >6 cm; often massive colonic dilation | Most common volvulus (60–75%); elderly/institutionalized patients; chronic constipation; sigmoid redundancy; endoscopic decompression often successful; high recurrence; sigmoidectomy definitive |
| Cecal volvulus | Cecum absent from RLQ; dilated ovoid gas-filled cecum in left mid-abdomen or LUQ; "coffee bean" opening toward LUQ; small bowel dilation; CT: whirl sign at ileocecal junction; cecum >10 cm; dilated terminal ileum; appendix may be visible with cecum | Second most common volvulus (25–40%); younger patients; congenital lack of retroperitoneal fixation; right hemicolectomy required; endoscopic decompression generally not definitive; high failure/recurrence rate; cecal bascule variant (folding without twisting) |
| Gastric volvulus — organoaxial | Stomach rotates around long axis (cardiopyloric axis); greater curvature flips superiorly; two air-fluid levels on upright CXR (double bubble); inversion of stomach; NGT cannot be passed; associated with diaphragmatic defect | More common type; associated with paraesophageal/diaphragmatic hernia; Borchardt triad: severe epigastric pain + retching without vomiting + inability to pass NGT; surgical emergency if strangulation |
| Gastric volvulus — mesenteroaxial | Rotation around short axis (perpendicular to cardiopyloric axis); antrum rotates anteriorly and superiorly; intermittent symptoms; partial obstruction pattern | Less common; often intermittent and partial; associated with diaphragmatic eventration; may reduce spontaneously; surgical repair of predisposing defect |
References
Peterson CM et al. Volvulus of the gastrointestinal tract. AJR. 2009;192(2):W105–15.
Radiopaedia — Sigmoid volvulus
Radiopaedia — Gastric volvulus (with diagrams)