Presentation
Presented with signs of large bowel obstruction.
Patient Data
Age: 30 years
Gender: Male
From the case:
Sigmoid volvulus
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The scout view demonstrates three specific signs:
- coffee bean sign of the markedly dilated loop of the colon
- liver overlap sign: the sigmoid loop is extended to the right upper quadrant and projecting over the liver shadow.
- northern exposure sign: the apex of the sigmoid volvulus is seen above or cranial to the transverse colon
The CT scan demonstrates:
- large gas-filled sigmoid colon forming a closed-loop obstruction, extending to the upper quadrants projecting, over the liver shadow, giving the liver overlap sign ( as described on the scout-view)
- the apex of the distended sigmoid colon is located above the transverse colon on the coronal reformat " northern exposure sign"
- twisting of the sigmoid mesentery and mesenteric vessels giving the "whirlpool appearance"
- crossing loops of bowel at the site of the transition in the left flank "X-marks-the-spot sign"
- minimal intraperitoneal effusion
- no evidence of perforation or bowel ischaemia
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