Bowels not open three days; distended abdomen; vomiting.
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Extensive gaseous distension of the large bowel, extending from the cecum to the distal sigmoid colon. The transition point lies within the central abdomen, and demonstrates a "bird's beak" appearance and twisting of the mesentery consistent with sigmoid volvulus. No pneumoperitoneum or free intra-abdominal or pelvic fluid.
Atrophic left lobe, otherwise the liver is unremarkable. The spleen, pancreas, kidneys, adrenals and gallbladder have a normal appearance.
Large bowel obstruction due to sigmoid volvulus.