Presentation
Abdominal discomfort and vomiting. Bowels not opened for 3 days.
Patient Data
Age: 90 years
Gender: Male
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Findings:
- a sigmoid volvulus is present
- twist in the sigmoid and sigmoid mesentery is located 13cm above the anal verge
- associated with moderate dilatation of the sigmoid proximally measuring 13cm in diameter
- the entire large bowel is also dilated with gas and feces to the level of the competent ileocecal valve
- small bowel and duodenum unremarkable
Conclusion:
- sigmoid volvulus with large bowel obstruction
- no perforation
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There is marked gaseous distension of the large bowel, with moderate fecal material also noted. No gas is identified in the rectum. A loop of markedly distended bowel is seen to the right of midline suggesting sigmoid volvulus, although there is no "coffee bean" sign. There is no free gas beneath the diaphragm on the erect chest x-ray.
Case Discussion
90-year-old male.
Presented with sigmoid volvulus.
Underwent flexible sigmoidoscopy and successful decompression.