Sigmoid volvulus

Case contributed by Dr Yair Glick

Presentation

Abdominal pain and distension and nausea. Vomited in the ER.

Patient Data

Age: 85 years
Gender: Male
X-ray

Large amount of fecal matter in the ascending and transverse colon.
Grossly dilated dolichosigma and splenic flexure of colon with air-fluid levels, both displacing the diaphragm upward. Positive Northern exposure and liver overlap signs - high suspicion of sigmoid volvulus.
Sternotomy closure wires superimposed on the spine.

CT

The sigmoid colon is markedly dilated, with air-fluid levels, and twists around its short axis at its distal part.
The ascending and transverse colon is filled with solid feces and the cecum is dilated.

Case Discussion

The patient went on to have a colonoscopy, where a large amount of feces was suctioned but the volvulus did not untwist. Abdominal pain and distension recurred and so the patient went on to have an emergent sigmoidectomy with descending colostomy.
 

Pathology report: The colonic mucosa shows ischemic necrosis secondary to volvulus.

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