Presentation
Abdominal distension and no bowel opening for one week.
Patient Data
"Coffee bean appearance". Severely dilated large bowel with absence of rectal gas. No evidence of small bowel dilation.
There are gross dilatations of the large bowel with a maximal diameter of 7.5 cm. A transitional zone is present at the sigmoid colon, with adjacent twisting of the mesentery and the mesenteric vessels, creating a whirlpool sign. No pneumoperitoneum is observed, and there is no free fluid.
Case Discussion
A radiograph can often suggest the presence of sigmoid volvulus; however, a CT scan may be necessary if bowel ischemia is suspected or if rectal decompression has failed, as it can help identify other associated complications. Signs of sigmoid volvulus to look for on a CT scan include the absence of rectal gas, an inverted U-shaped distended sigmoid colon, the coffee bean sign, and disproportionate enlargement of the sigmoid colon 1.
One of the most sensitive findings to evaluate on CT is the transition point of the sigmoid colon, which is followed by disproportionate enlargement of the sigmoid 1.
It's important to note that the "bird beak" sign is not exclusive to sigmoid volvulus and can be observed in other types of volvulus as well. This sign represents the gradual tapering of the caliber of the sigmoid volvulus at the point of obstruction, which can be visualized in contrast or barium studies, as well as in CT scans.
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