Sigmoid volvulus and large bowel obstruction

Case contributed by Dr Varun Babu

Presentation

Non specific abdominal pain, vomiting and abdominal distension

Patient Data

Age: 50 years
Gender: Male
X-ray

Initial Abdomen frontal radiograph

Raised intraabdominal pressure secondary to gaseous distension of small and large bowel suggestive of a distal large bowel obstruction. Patient was later admitted and a nasogastric tube was inserted while preparations were made for an abdominal CT scan. 

X-ray

8 hours post admission and an NG tube insertion

8 hours post-admission and nasogastric tube insertion, there was no relief in the findings suggestive of some form of distal large bowel obstruction. 

CT

CT abdomen and pelvis with oral positive and i.v. iodinated contrast.

CT confirms the findings of a distal large bowel obstruction. Whirlpooling of mesentery of the sigmoid colon with a clear transition zone is identified in the rectosigmoid. Proximal to it there is coffee bean like distension of the large bowel, accumulation of feces in small bowel, all in keeping with an ongoing large bowel obstruction. There is no features of bowel ischemia. Mesenteric vessels are patent. No free intraperitoneal air. 

X-ray

2 hours after abdominal CT scan done

2 hours after the patient was prepared with oral contrast for an abdominal CT, the findings persisted with patterns of a coffee bean sign becoming more apparent. 

Case Discussion

There was no hesitation to immediately take up the patient for surgery and detorsed. Thankfully the involved segment of bowel was not ischemic, and a sigmoidopexy and mesenteric plication was done. 

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Case information

rID: 46103
Published: 21st Jun 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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