Volvulus

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.
  • The "coffee bean" is: large bowel folded over itself and twisted in away that creates two compartments.

Images

• 

  Volvulus at surgery. (WC)

• 

  X-ray coffee bean sign in volvulus. (WC)

www

• Cecal volvulus (utah.edu).
• Volvulus (uic.edu).

Microscopic

Features:

• +/-Ischemic changes and/or necrosis.

DDx:

• Essentially anything that causes ischemia:
  • Embolus.
  • Thrombosis.
  • Vasculitis.
  • Others.

Sign out

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

• Colon.