Volvulus

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Volvulus is a benign colonic pathology of the cecum or sigmoid colon.

General

  • Uncommon specimen.
  • It is essentially a radiologic diagnosis.
  • In the context of autopsy, it is a gross diagnosis.

Gross

  • Intestine folded over itself - typically leads to ischemia.

Radiology

  • In the context sigmoid volvulus - the colon may be described as having a coffee bean sign.[1]
    • The "coffee bean" is: large bowel folded over itself and twisted in away that creates two compartments.[2]

Images

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Microscopic

Features:

DDx:

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Sigmoid Colon, Excision:
     - Colonic wall with submucosal edema and zonal early degenerative 
       change of the mucosa, see comment.
     - Three benign lymph nodes.
     - NEGATIVE for malignancy.

Comment:
The clinical and radiologic impression are noted; the changes are compatible with volvulus.

Block letters

RECTOSIGMOID, RESECTION:
- MURAL ISCHEMIA WITH PERFORATION, SEROSITIS, MICROABSCESS FORMATION AND POORLY FORMED PSEUDOMEMBRANES.
- SUBMUCOSAL FIBROSIS.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
The findings are consistent with volvulus and the submucosal fibrosis suggests this may have been recurrent.

See also

References

  1. Lee, YS.; Lee, WJ. (Jun 2008). "Coffee-bean sign.". CMAJ 178 (13): 1657. doi:10.1503/cmaj.071760. PMID 18559802.
  2. Moseley, BD.; Bhagra, A. (Nov 2009). "The coffee bean sign.". Int J Emerg Med 2 (4): 267-8. doi:10.1007/s12245-009-0134-7. PMID 20436903.
  3. URL: http://pathsrvr.rockford.uic.edu/inet/GI/GI%20Station%201.htm. Accessed on: 9 April 2012.