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CT can demonstrate a mechanical intestinal obstruction, and it can be used to differentiate between mechanical obstruction and adynamic ileus.

CT scans show the site of obstruction and its severity. A volvulus or strangulation generally causes a closed-loop obstruction, and CT characteristically demonstrates a U-shaped distended bowel segment and signs of ischemia. These signs include mural thickening, infiltration of the mesenteric fat, and pneumatosis intestinalis. In the presence of a cecal or sigmoid volvulus, a whirl sign may be apparent because of a tight torsion of the mesentery that is caused by a twist between the afferent and efferent loops.12,
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CT scan findings of sigmoid volvulus include the whirl sign, which represents tension on the tightly twisted mesocolon by the afferent and efferent limbs of the dilated colon.11, 12 CT scanning may be useful in identifying the etiology and site of the obstruction that result from other pathologies, as well as in demonstrating ischemia that results from strangulation. CT scan signs of ischemia include a serrated beak at the site of the obstruction, mesenteric edema or engrossment, and moderate to severe thickening of the bowel wall. Intramural gas or portal venous gas may be seen (grave prognostic signs), and in patients in whom a perforation has occurred, a large amount of free intraperitoneal gas or fluid may be noted.

MRI has been used successfully in the assessment of large-bowel obstruction (not specifically in sigmoid volvulus). These examinations were performed with the retrograde insufflation of 1000-1200 mL of air through a Foley catheter that was placed in the rectum and with scopolamine to inhibit peristalsis in order to demonstrate the site of bowel obstruction. In addition, MRI has been used in the diagnosis of mural necrosis in infants and, theoretically, this modality can be used in adults.

CT scan is used for staging colon cancer before surgery, for assessing and staging recurrent disease, and for detecting the presence of distant metastases. Preoperative CT scan is indicated if there is clinical suggestion of distant metastases or local invasion of the adjacent organs or abdominal wall. In older patients who may be unable to undergo colonoscopy or barium enema, modified CT scan may be performed for primary detection of colorectal tumors. Colonic tumors may be diagnosed on CT scan as an incidental finding.

MRI provides greater contrast between soft tissues than CT scan. Colonic tumors have low signal intensity (similar to adjacent skeletal muscle) on T1weighted sequences, which facilitates their differentiation from high-signal perirectal fat. T2-weighted images are used to detect pelvic sidewall invasion. Tumor enhancement can be achieved by paramagnetic agents such as gadolinium.

A localized tumor may be seen on CT scan as an intraluminal or intramural mass of soft tissue density adjacent to the gas-filled or contrast-filled bowel lumen; More advanced tumors are associated with thickening of the bowel wall (>6 mm) and infiltration of the pericolic fat. Thin strands of tissue may extend from the tumor into the pericolic fat . Annular carcinomas are detected by a thickening of the bowel wall and narrowing of the lumen. This thickening is concentric if the scanning plane is at right angles to the long axis of the bowel Extracolonic tumor spread is indicated by a loss of tissue fat planes between the colon and surrounding structures. Invaded muscle may be enlarged . Colonic tumors may invade the anterior abdominal wall, liver, pancreas, spleen, or stomach.

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