Presentation
Exclude obstruction
Patient Data
Large bowel is dilated with a diameter reaching 13 cm, the dilated portions have a coffee bean type configuration, apex at the left iliac fossa. This is consistent with a sigmoid volvulus.
Flatus tube inserted, successfully decompressed. CT abdomen performed to better assess
Status post sigmoid volvulus decompression; a sigmoid catheter is inserted and intraluminal in location within the sigmoid. The sigmoid and IMA remain normally aligned. The sigmoid colon is distended with an air fluid level measuring up to the 7.1 cm in diameter, with a mildly thickened circumferential wall which may reflect edema. No pericolic fat stranding or collection. Rectum is distended with fluid. No extrinsic lesion is identified. The remainder of the bowel is normal.
Ovoid hyperdensities within the stomach are consistent with tablets. Hypodense attenuation of the liver adjacent the gallbladder fossa is likely consistent with fatty infiltration. Multiple regions of capsular retraction within the spleen in conjunction with the small size is consistent with previous infarcts. Diffuse fat stranding through the upper thighs and buttocks is consistent with third spacing. Atheroma of the abdominal aorta and iliac arteries.
Case Discussion
Sigmoid volvulus is a cause of large bowel obstruction and occurs when the sigmoid colon twists on the sigmoid mesocolon. Often taking the appearance of a coffee bean on plain film imaging.
CT report courtesy of Dr. Aileen Cormican
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