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Nakamata A, Matsuki M, Watanabe Y, Kobayashi R, Fujii N, Kunitomo N, Otake Y, Fujii H, Hamamoto K, Mori H. Imaging Features of Uncommon Entities That Manifest with Torsion. Radiographics 2024; 44:e230101. [PMID: 38870044 DOI: 10.1148/rg.230101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Torsion is the twisting of an object along the axis, and various structures (organs and tumors) in the body can twist. Torsion causes initial lymphatic and venous outflow obstruction, leading to congestive edema, enlargement, venous hemorrhagic infarction, and surrounding edema. It can also cause subsequent arterial obstruction depending on the degree of torsion, leading to ischemia, infarction, necrosis, gangrene, and surrounding inflammation. Therefore, in several cases of torsion, immediate surgical intervention is required to improve blood flow and prevent serious complications. Clinical manifestations of torsion are often nonspecific and can affect individuals of varying ages and sex. Imaging plays an important role in the early diagnosis and management of torsion. Multiple imaging modalities, including US, radiography, CT, and MRI, are used to evaluate torsion, and each modality has its specific characteristics. The imaging findings reflect the pathophysiologic mechanism: a twisted pedicle (whirlpool sign), enlargement of the torsed structures, reduced blood flow, internal heterogeneity, and surrounding reactive changes. The whirlpool sign is a definitive characteristic of torsion. In some cases, despite poor internal enhancement, capsular enhancement is observed on contrast-enhanced CT and MR images and is considered to be associated with preserved capsular arterial flow or capsular neovascularization due to inflammation. Radiologists should be familiar with the pathophysiologic mechanisms, clinical characteristics, and imaging characteristics of torsion in various structures in the body. Since other articles about common organ torsions already exist, the authors of this article focus on the uncommon entities that manifest with torsion. ©RSNA, 2024.
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Affiliation(s)
- Akihiro Nakamata
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Mitsuru Matsuki
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Yuriko Watanabe
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Ryoma Kobayashi
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Nana Fujii
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Naoki Kunitomo
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Yuko Otake
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Hiroyuki Fujii
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Kohei Hamamoto
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Harushi Mori
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
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Kawai H, Omura N, Hirabayashi T, Shimada T, Kawahara H. Small Bowel Obstruction Due to Axial Torsion of Meckel's Diverticulum: A Case Report and Literature Review. Cureus 2023; 15:e50934. [PMID: 38249182 PMCID: PMC10800028 DOI: 10.7759/cureus.50934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Meckel's diverticulum (MD) is a commonly encountered congenital gastrointestinal abnormality. Although the frequency of MD-related complications such as inflammation or bleeding is relatively high, small bowel obstruction induced by axial torsion of the MD is rare. Therefore, we herein report such a case along with a review of the literature. A 34-year-old female with right lower quadrant pain, nausea, and vomiting was admitted to our hospital with the diagnosis of adhesive small bowel obstruction due to a cesarean section performed five years previously. A long intestinal tube was placed, and the patient's clinical symptoms and X-ray findings showed relief of the small bowel obstruction. However, she developed severe right lower quadrant pain after contrast examination through the long intestinal tube despite the fact that the contrast agent had smoothly reached the terminal ileum. Blood tests and enhanced computed tomography (CT) showed a remarkable elevation of inflammatory markers, the appearance of ascites, and closed-loop-like and abscess-like appearances near the site of the caliber change. With a diagnosis of internal hernia, the patient underwent emergency laparotomy by means of a midline incision. Purulent ascites was observed within the abdominal cavity. Small bowel obstruction caused by a single band was observed in the right lower quadrant. Further exploration revealed an inflammatory MD with neck torsion and a mesodiverticular band (MDB). Simple mesodiverticular band resection by electrocautery and diverticulectomy by linear stapler were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. In the case of juvenile-onset small bowel obstruction, axial torsion of the MD should be considered as a differential diagnosis. Herein, we report such a difficult diagnostic case and the first English literature review of small bowel obstruction due to axial torsion of the MD.
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Affiliation(s)
- Hironari Kawai
- Surgery, Nishisaitama-Chuo National Hospital, Tokorozawa, JPN
| | - Nobuo Omura
- Surgery, Nishisaitama-Chuo National Hospital, Tokorozawa, JPN
| | | | - Tetsuya Shimada
- Pathology, Nishisaitama-Chuo National Hospital, Tokorozawa, JPN
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