I have asked this question three times already and have had no response as yet from our millions of members. Imaginary sketches are not valid.
The most recent photograph I saw was Bascule Cecal Volvulus: J.Ramsingh, et.al. JSCR. 2014: 4, from Royal Alexandra Hosp, UK. It was not a Cecal Bascule nor a Volvulus. It was a preternaturally mobile Cecocolon in partial torsion ( not a volvulus - which is a completed 360 degree torsion) with barium enema flowing through and the small intestines were collapsed. A cecal Volvulus, if ever it exists, is a diagnosis of immediate surgical urgency. Temporising neglects less urgent diagnoses that also needs attention.
Dear Dr Tirol
I was interested when I first read your question, and have been waiting for responses - but there have not been any. I looked to see if I could see anything of interest and found the below. Some papers were very old, but these are reasonably recent:
Fig. 3d in: Macari, M., Spieler, B., Babb, J., & Pachter, H. L. (2011). Can the location of the CT whirl sign assist in differentiating sigmoid from caecal volvulus?. Clinical radiology, 66(2), 112-117.
http://www.sciencedirect.com/science/article/pii/S0009926010003612
Fig. 2 in: Tirol, F. T. (2005). Cecocolic torsion: classification, pathogenesis, and treatment. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 9(3), 328.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015600/
But they may not meet your criteria,
Mary
Dear Ms Wilson, ( MD ?)
Please permit me to reiterate to avoid confusion: Dictionary definition of (1) Torsion is a twisting (it may partially or completely obstruct the lumen) and (2) Volvulus forms a Knot ( it will always obstruct and even strangulate). The cecum has no mesentery. It has an anterior and a posterior cecal artery that courses along it and not like a vasa recta that penetrates the bowel transversely
The Fig. 2, was Acute Cecocolic Torsion mistaken preop for Ogilvie's Syndrome by the gastroenterologist and misnamed as a Volvulus by many of the misinformed. Fig. 1 is an actual Cecal Bascule. I operated on the patient and it was still viable and was successfullycecopexed with cecoctomy. See figure 6 which is a Cecocolic Pseudotumor from the chronicity of the recurrent torsion and spontaneous resolution.
As for the "Whirl sign", it is not pathognomonic of Cecal Volvulus because it could also be seen in any volvulate with a torsed mesentery, omentum, infundibulo-pelvic ligament, etc. I shall search that article and get back to you.
Thank you, Dr Tirol. No, I'm not MD but before retirement did work with people with bowel problems but from a (community) nurse practitioner / qualitative research perspective. But I find any related issues of interest, which was why I was hoping that you would receive RG answers.
Dear Ms. Wilson,
Being a computer moron I could not generate the picture that you cited by Macari, Spieler, et al. Iwould however contend that the whirl sign can only occur if there is a twisting tether holding an organ .
The cecum has no mesentery therefore it can not torse into a volvulus! It is wider than long, so it can not twist on itself. Cecal Volvulus does not exist!
What everyone that I have read out there is calling a cecal volvulus is actually a Cecocolic T orsion which includes the unfixed ascending colon. If ever it forms into a volvulus it would include the ileum and ascending colon torsing on the ileal mesentery and ascending mesocolon. If it is not the cecum alone and if it does not form a knot then it is not a cecal volvulus. This is the reason for the diagnnostic confusion and missed diagnoses.
The problem is that there are many patients out there who are not diagnosed although the process of torsion per se is symptomatic. These patients are in pain. Meanwhile we await the diagnosis of a volvulus,
Thank you for your response.
Dear Dr Tirol,
Thank you for this. I value your explanation, which I shall need to read carefully in order to understand it.
Very much appreciate you spending time to respond,
Mary
Dear Mary,
= You are on the right track. Many physicians are deductive "a priori" thinkers and await a consensus--- which is what the diagnosis of Cecal Volvulus is. It is a myth!
An inductive "a [postriori" determinative approach defines the pathogenesis and many diseases can be diagnosed while still in the process. To await a fully blooming morphological entity, which may be stochastic, is misleading and p[atients suffer meanwhile..Worse is that stubborn insistence on a diagnostically fallacious nomenclature.
Both mental mechanisms should be availed from by diagnosticians.
My very best wishes to you.
Dr. Tirol
Dear Ms. Wilson,
Correction of a typo: - "a posteriori"= meaning- what comes after, inductive.
Sorry,
Dr. Tirol
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