Presentation
Abdominal pain and distention.
Patient Data
Medium to large amount of colon stool. Slight turning/narrowing of afferent distal descending colon with obstruction. This transitions into dilated, air-filled sigmoid colon with the classic "coffee bean" shape (see the scout). Rapid taper of dilated more distal sigmoid colon into a twisted segment. The volvulus is best appreciated on the coronal and axial images. Thickening of the rectum is likely due to vascular congestion.
Hiatus hernia.
Arrows indicate the afferent loop (distal descending colon entering the volvulus) and the efferent loop (distal sigmoid colon twisting as it exits the volvulus).
Case Discussion
Classic case of sigmoid volvulus. The afferent loop of distal descending colon twists and narrows as it enters the volvulus without becoming completely obstructed, although some degree is likely present based on the amount of upstream stool. The efferent loop is clearly obstructed, resulting in massive distention of the sigmoid colon, forming the classic "coffee bean" sign. Thickening of the rectum is likely due to congestion as the superior rectal vessels are involved in the volvulus (IMA twists on the axial images).
From the colonoscopy report: "The procedure began by inserting a lubricated video colonoscope through the anus, and advancing it to the level of the volvulus. There was narrowing of the lumen with a swirl pattern to the mucosa. The scope was slowly advanced as irrigation and suction was applied, and ultimately the loop was entered, it was decompressed. The scope was then advanced out through the proximal area of twisting and advanced into non-prepared stool-filled colon."
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