Presentation
2 days of abdominal distension and no bowel movements.
Patient Data
Gas filled viscus extending from pelvis towards left upper quadrant suggestive of sigmoid volvulus.
There is a twist involving the sigmoid colon and it's mesentery, identified most clearly by following the swirling vessels. The apex of the sigmoid points to the left upper quadrant. There is also gaseous distension of the remaining large bowel. Long standing left hemidiaphragmatic paralysis.
Case Discussion
The classic signs of sigmoid volvulus seen in this study are the coffee bean sign on the x-ray and the whirl sign on the CT. The sigmoid colon and its mesentery twist with subsequent marked distension of the apex which tends to point to the left upper quadrant, and distension of the proximal large bowel. This is in contrast to a cecal volvulus where the large bowel distal to the cecum is usually collapsed.
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