Sigmoid volvulus

Case contributed by Dr Derek Smith

Presentation

5 days of constipation, now not passing flatus. Distended abdomen. No previous surgical history. ?obstruction ?malignant lesion

Patient Data

Age: 70 years
Gender: Male
X-ray

Distended large bowel loops, with right colon fecal loading. No SBO. No free gas or toxic features.

CT

Sigmoid volvulus; typical "swirling" mesentery and caliber change (see coronal images). Maximal dilatation 12 cm, with approimately 100 cm of involved colon. No pneumatosis or perforation. No obstructing mass or extraluminal lesion.

The proximal colon and small bowel are not obstructed. Local inflammatory changes around the colon on the mesenteric border and along the mesentery. Small volume free fluid in both paracolic gutters and the pelvis, but no collection or significant nodal enlargement.

Left lower renal calculus and simple cortical cyst. Otherwise normal kidneys, liver, biliary system, spleen and adrenal.

Lung bases clear.

Normal included skeleton.

X-ray

Three months later

Recurrent sigmoid volvulus with paucity of rectal gas and proximal large bowel distention/obstruction.

Case Discussion

Slightly atypical appearance of sigmoid volvulus - proximal large bowel obstruction is usually described with this condition. On this study and an earlier CT there is plenty of redundant sigmoid colon (with about 1 m involved in this volvulus), which is a predisposing factor.

This case was managed with decompression by flexible sigmoidoscopy. Typical for sigmoid volvulus, he soon represented with recurrent distention and volvulus.

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Case information

rID: 61177
Published: 21st Jun 2018
Last edited: 21st Jun 2018
Inclusion in quiz mode: Included

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