Sigmoid volvulus

Case contributed by Dr Henry Knipe

Presentation

Three days of bowels not opening and increasing abdominal distension.

Patient Data

Age: 82
Gender: Male
Modality: X-ray

Grossly-dilated loop of large bowel has a 'coffee-bean shape' and the descending colon tapers in its inferior portion in keeping with a sigmoid volvulus. Air-fluid levels on erect projection.

Modality: CT

Grossly dilated loop of sigmoid colon with whirl sign of the sigmoid mesentery. Fat stranding of the sigmoid mesentery. No mural thickening appreciated. Remainder of the colon and small bowel is unremarkable.

Liver, gallbladder, spleen and pancreas have a normal appearance as for the patient's age and non-contrast study. Atrophic kidneys with 1.7 centimetre hypodensity and 1.1 centimetre exophytic hypodensity at the left interpolar region. Small volume of perisplenic free fluid. No free gas. Lung bases are clear. Degenerative lumbar spine changes.

Case Discussion

The large central lower-abdominal gas-filled viscus represents the distended sigmoid colon that has volved at its mesenteric base causing obstruction. On the coronal reformat of the CT, the swirling pattern of the vessels at the base of the mesentery is seen and confirms the cause of sigmoid distension.

Features here are of sigmoid volvulus.

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Case Information

rID: 28620
Case created: 3rd Apr 2014
Last edited: 28th Jun 2016
Inclusion in quiz mode: Included

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